Provider Demographics
NPI:1508442955
Name:KANTONO, MELVIN (DO)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:KANTONO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15855 POMONA RINCON RD BLDG 4
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5572
Mailing Address - Country:US
Mailing Address - Phone:909-929-2511
Mailing Address - Fax:
Practice Address - Street 1:15855 POMONA RINCON RD BLDG 4
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5572
Practice Address - Country:US
Practice Address - Phone:909-929-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A22504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine