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NPI Code Detail

MEDICARE: DR. DWIGHT HISAYUKI MUKUNO M.D.

MEDICARE: DR. DWIGHT HISAYUKI MUKUNO 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
12085B0100XBody Imaging PhysicianG40177CA
22085R0202XDiagnostic Radiology PhysicianG40177CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00176690OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G401770OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1790720019
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DWIGHT HISAYUKI MUKUNO M.D.
Provider Business Mailing Address
First Line : 3160 FOLSOM BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-5219
Country : US
Telephone Number : 916-733-5701
Fax Number : 916-733-3401
Provider Business Practice Location Address
First Line : 6305 COYLE AVE
Second Line :
City : CARMICHAEL
State : CA
Zip : 95608-0438
Country : US
Telephone Number : 916-961-6920
Fax Number : 916-966-5063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 08/21/2007

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