Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 24317 | CA |
NPI | 1003814393 |
---|---|
Provider Name | Dr. Wilson S. Morishita |
First Address | Pasadena, CA 91101-4457 |
Second Address | Pasadena, CA 91101-4457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 08/07/2007 |