Individual
DR. JACQUES KPODONU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
447 OLD NEWPORT BLVD. #200, NEWPORT BEACH, CA 92663-4257
(949) 650-3350
(949) 650-1274
Mailing address
447 OLD NEWPORT BLVD. #200, NEWPORT BEACH, CA 92663-4257
(949) 650-3350
(949) 650-1274
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A72779
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141743
—
AZ
01
—
1750339479
GROUP NPI
CA
01
—
A72779
LICENSE
CA
01
—
P00333876
RAILROAD MEDICARE AHI
AZ
01
—
WCSKQ
SUN HEALTH GROUP # AHI
AZ
Enumeration date
07/09/2006
Last updated
03/07/2023
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