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General NPI Number Information
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NPI Number | 1780664581
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Entity Type | Individual
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Provider Name | JONARDI HANDOKO MD
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 811 E 11TH ST STE 206
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-931-3727
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Fax | 909-931-3729
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Provider Business Mailing Address
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Address Line | 811 E 11TH ST STE 206
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-931-3727
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Fax | 909-931-3729
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A43851
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A43851
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License Number State | CA
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