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NPI Code Detail

MEDICARE: JOHAN WINOTO M.D.

MEDICARE: JOHAN WINOTO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology PhysicianA116149CA
2207RN0300XNephrology Physician35090745OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00981485OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780635920
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHAN WINOTO M.D.
Provider Business Mailing Address
First Line : 1111 EXPOSITION BLVD STE 300
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-4324
Country : US
Telephone Number : 916-929-8564
Fax Number : 916-929-4529
Provider Business Practice Location Address
First Line : 2218 KAUSEN DR STE 103
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-7178
Country : US
Telephone Number : 916-683-8774
Fax Number : 916-683-8777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 06/13/2025

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Directions to “ JOHAN WINOTO M.D.” Practice Location

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