Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | LPT-31876 | AZ |
Y | 213ES0000X | Sports Medicine | LPT-31876 | AZ |
NPI | 1427729300 |
---|---|
Provider Name | Jesse Kunitomo |
First Address | Scottsdale, AZ 85254-4062 |
Second Address | Scottsdale, AZ 85254-4062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |