Provider Demographics
NPI:1922103860
Name:MA'O, KURENE T (MD)
Entity Type:Individual
Prefix:
First Name:KURENE
Middle Name:T
Last Name:MA'O
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21501 AVALON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2222
Mailing Address - Country:US
Mailing Address - Phone:310-835-6627
Mailing Address - Fax:310-835-9830
Practice Address - Street 1:21501 AVALON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2222
Practice Address - Country:US
Practice Address - Phone:310-835-6627
Practice Address - Fax:310-835-9830
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA71054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A645520Medicaid
G61812Medicare UPIN