Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A9217 | CA |
NPI | 1306861729 |
---|---|
Provider Name | Dr. Michael Kurisu |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 07/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I51027 | (02) | CA |