Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | AT5466 | CA |
NPI | 1013296094 |
---|---|
Provider Name | Tye Ichiro Masaki |
First Address | Cypress, CA 90630-5137 |
Second Address | Cypress, CA 90630-5137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2011 |
Last Update Date | 09/08/2011 |