Healthcare Provider Details

I. General information

NPI: 1902994437
Provider Name (Legal Business Name): DONNA AIKO KONO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELDS AVE
DAVIS CA
95616-5270
US

IV. Provider business mailing address

4354 ATLANTIS DR.
DAVIS CA
95618
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-2300
  • Fax: 530-752-2306
Mailing address:
  • Phone: 530-750-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG49948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: