Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DB034625 | CA |
Y | 213EG0000X | General Practice | DB034625 | CA |
NPI | 1003038019 |
---|---|
Provider Name | Dr. Mark Atsushi Kujiraoka |
First Address | Gold River, CA 95670 |
Second Address | Sacramento, CA 95821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |