Glenn D. Madokoro, M.D, F.a.C.G., Inc.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

G30192 Issued in CA

Legal business name

GLENN D. MADOKORO, M.D, F.A.C.G., INC.

Practice address

351 Hospital Rd
Suite 210
Newport Beach, CA 92663-3509

Phone

(949) 548-8800

Fax

(949) 548-0248

NPI assigned

May 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn Douglas Madokoro, M.D.

Title

President

Phone

(949) 548-8800

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282608000000",
    "number": "1699980995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 HOSPITAL ROAD",
            "address_2": "SUITE 210",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633509",
            "telephone_number": "949-548-8800",
            "fax_number": "949-548-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 HOSPITAL RD",
            "address_2": "SUITE 210",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633509",
            "telephone_number": "949-548-8800",
            "fax_number": "949-548-0248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN D. MADOKORO, M.D, F.A.C.G., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2010-08-24",
        "status": "A",
        "authorized_official_last_name": "MADOKORO",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-548-8800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "G30192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.