Healthcare Provider Details

I. General information

NPI: 1457329955
Provider Name (Legal Business Name): CRAIG MASAO ONO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 E BEVERLY AVE STE 102
KINGMAN AZ
86409-3593
US

IV. Provider business mailing address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-8693
  • Fax: 928-681-8694
Mailing address:
  • Phone: 928-263-4722
  • Fax: 928-263-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number06255
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: