Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 302700 | NY |
NPI | 1003233966 |
---|---|
Provider Name | Kohtaro Ooka |
First Address | New York, NY 10029-6552 |
Second Address | New York, NY 10016-6402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 09/08/2021 |