Basic Information
| Provider Information | |||||||||
| NPI: | 1285862615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANU | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 660940 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910660940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264470206 | ||||||||
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| Practice Location | |||||||||
| Address1: | 825 DELBON AVE | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953822016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096642790 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A122316 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 21758 | MS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | A122316 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | A122316 | 01 | CA | MEDICAL LICENSE | OTHER |