Provider Demographics
NPI:1487792511
Name:KITAJI, JON (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:KITAJI
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 1:757 PACIFIC STREET
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2819
Mailing Address - Country:US
Mailing Address - Phone:831-375-6802
Mailing Address - Fax:831-375-0958
Practice Address - Street 1:757 PACIFIC STREET
Practice Address - Street 2:SUITE D-2
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2819
Practice Address - Country:US
Practice Address - Phone:831-375-6802
Practice Address - Fax:831-375-0958
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37680207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0093830Medicaid
CAZZZ32122ZMedicare ID - Type Unspecified
CAGR0093830Medicaid