Provider Demographics
NPI:1861427437
Name:KANO, HENRY LOC (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LOC
Last Name:KANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 W GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695
Mailing Address - Country:US
Mailing Address - Phone:530-666-1631
Mailing Address - Fax:
Practice Address - Street 1:632 W GIBSON RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-666-1631
Practice Address - Fax:530-668-4839
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G749080Medicaid
CA370007252OtherMEDICARE RAILROAD CARRIER
CA370004307OtherRR MEDICARE
CA00G749080OtherBLUE SHIELD
F86508Medicare UPIN
CABG849ZMedicare PIN
CA00G749080Medicare ID - Type Unspecified