Provider Demographics
NPI:1669562427
Name:WENOKUR, RANDALL K (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:K
Last Name:WENOKUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6600 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5256
Mailing Address - Country:US
Mailing Address - Phone:925-685-7400
Mailing Address - Fax:925-685-0917
Practice Address - Street 1:6600 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5256
Practice Address - Country:US
Practice Address - Phone:925-685-7400
Practice Address - Fax:925-685-0917
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF80706207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG67072OtherLICENSE
ZZZ21406ZOtherMEDICARE GROUP #
CAG67072OtherLICENSE
F80706Medicare UPIN