Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | G64464 | CA |
NPI | 1073670675 |
---|---|
Provider Name | Dr. Jason I Tokumoto |
First Address | San Francisco, CA 94114-2824 |
Second Address | San Francisco, CA 94110-1210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 10/06/2014 |