Provider Demographics
NPI:1588649354
Name:HOSOUME, JOHN TAKEO (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TAKEO
Last Name:HOSOUME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 J ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4300
Mailing Address - Country:US
Mailing Address - Phone:916-734-7777
Mailing Address - Fax:916-734-8059
Practice Address - Street 1:2825 J ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-734-7777
Practice Address - Fax:916-734-8059
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G662020Medicaid
F19882Medicare UPIN
CA00G662020Medicare PIN