Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 00000000 | AZ |
Y | 208200000X | Surgeon | R78314 | AZ |
Y | 208600000X | Surgeon | R78314 | AZ |
NPI | 1720601941 |
---|---|
Provider Name | Keita Okubo |
First Address | Scottsdale, AZ 85259-5452 |
Second Address | Scottsdale, AZ 85259-5452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2020 |
Last Update Date | 09/09/2020 |