Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95007597 | CA |
NPI | 1003322306 |
---|---|
Provider Name | Katherine Lin Matsumoto |
First Address | Irvine, CA 92604-4697 |
Second Address | Irvine, CA 92604-4697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2017 |
Last Update Date | 21/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
95007597 | NURSE PRACTITIONER LICENSE (01) | CA |