Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT11148 | CA |
N | 2251H1200X | Hand | PT11148 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT11148 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT11148 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT11148 | CA |
NPI | 1104864701 |
---|---|
Provider Name | Ms. Lynn Toshiko Kanda |
First Address | Fountain Valley, CA 92708-3846 |
Second Address | Fountain Valley, CA 92708-3846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 08/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT11148 | STATE LICENSE (01) | CA |