Healthcare Provider Details

I. General information

NPI: 1811087752
Provider Name (Legal Business Name): JOHN JAMES LUBENKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/23/2025
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 E KINGS CANYON RD
FRESNO CA
93727-3812
US

IV. Provider business mailing address

4929 E KINGS CANYON RD
FRESNO CA
93727-3812
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-6476
  • Fax: 559-255-6476
Mailing address:
  • Phone: 559-255-6476
  • Fax: 559-255-6476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG29551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: