1124297395 NPI number — DR. HIROSHI KAN KATSUMI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124297395 NPI number — DR. HIROSHI KAN KATSUMI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATSUMI
Provider First Name:
HIROSHI
Provider Middle Name:
KAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124297395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
393 E WALNUT ST
Provider Second Line Business Mailing Address:
PHR GROUP PROVIDER ENROLLMENT UNIT, 3RD FL
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-608-0044
Provider Business Mailing Address Fax Number:
877-514-0903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 THE CITY DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-6357
Provider Business Practice Location Address Fax Number:
714-456-5342
Provider Enumeration Date:
02/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  A93331 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0085140 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W14887 . This is a "MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W457 . This is a "PALMETTO GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ54082Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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