Individual
JONARDI HANDOKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
811 E 11TH ST, STE 206, UPLAND, CA 91786
(909) 931-3727
(909) 931-3729
Mailing address
811 E 11TH ST, STE 206, UPLAND, CA 91786
(909) 931-3727
(909) 931-3729
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A43851
CA
207RN0300X
Nephrology Physician
Primary
A43851
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A43851
SOUTHERN CALIFORNIA
CA
05
—
OOA438511
—
CA
Enumeration date
01/18/2006
Last updated
07/13/2010
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