Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A103754 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A103754 | CA |
NPI | 1205090289 |
---|---|
Provider Name | Dr. Kentaro Pressly Suzuki |
First Address | Ventura, CA 93003-7844 |
Second Address | Ventura, CA 93003-3165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 03/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A103754 | STATE LICENSE (01) | CA |
FS3800718 | DEA (01) | CA |