Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 000052 | NY |
NPI | 1134536857 |
---|---|
Provider Name | Katsushi Okazaki |
First Address | Forest Hills, NY 11375-3629 |
Second Address | New York, NY 10010-4020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2014 |
Last Update Date | 01/03/2015 |