Karen S Mikuni, MD
Individual provider Active NPI Family Medicine Physician · Oceano, CA
NPI 1497748958 · NPPES record last updated Nov 7, 2017
Key facts
- NPI
- 1497748958
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G74101 (CA)
- Practice address
- 2120 Cienaga St
Oceano, CA 93445-9016 - Phone
- (805) 994-2100
- Fax
- (805) 994-2197
- NPI assigned
- Aug 30, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110916000304 | CA | Practitioner - Family Practice | 9638367857 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G74101 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Centers of the Central Coast Inc | Current | Accepting new patients | |
| Community Health Centers of the Central Coast Inc | Current |
Accepting new patients | |
| Community Health Centers of the Central Coast Inc | Current |
Accepting new patients | |
| Community Health Centers of the Central Coast Inc | Current | Accepting new patients | |
| Community Health Centers of the Central Coast Inc | Current | Accepting new patients | |
| Etnyre and Mikuni Medical Corporation | Family Medicine | Past | Accepting new patients |
| Pacific Central Coast Health Centers | Past | Accepting new patients |
Locations
150 Tejas Pl
Nipomo, CA 93444
Phone (805) 929-3254
2050 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8014
325 Posada Ln
Templeton, CA 93465
Phone (805) 239-0644
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G74101 | CA | Yes |
Addresses
Primary practice location
2120 Cienaga St
Oceano, CA 93445-9016
Mailing address
2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8028
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080142127 | Other | RAILROAD MEDICARE | |
| 00G741010 | Medicaid | CA | |
| CB207799 | Other | CA | MEDICARE ID |
| 00G741010 | Other | CA | BLUE SHIELD OF CALIFORNIA |
Other providers in Oceano, CA
- Juliet Iannoli-Ballard
- Mia Malotte Leeper
- Victoria Tafoya Lowrie
- Lucia Mar Unified School District
- Matthew Marron
- Kristyn Lauren Moore
- Duc Van Nguyen
- Sierra Rae Overton
- Daniel Enrique Parker Schmidt
- Maribel Ramirez
All providers in Oceano, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.