1104362029 NPI number — SHO KUDO M.D.

Table of content: DR. RICHARD BRADLEY ABEL M.D. (NPI 1508148016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104362029 NPI number — SHO KUDO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUDO
Provider First Name:
SHO
Provider Middle Name:
Provider Name Prefix Text:
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:
1104362029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5-7-62 OOTAKARA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGA
Provider Business Mailing Address State Name:
SAGA
Provider Business Mailing Address Postal Code:
8400811
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
81952287263
Provider Business Mailing Address Fax Number:
81952287263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141-11 SAKEMI
Provider Second Line Business Practice Location Address:
TAKAGI HOSPITAL
Provider Business Practice Location Address City Name:
OKAWA
Provider Business Practice Location Address State Name:
FUKUOKA
Provider Business Practice Location Address Postal Code:
8310016
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
81944870001
Provider Business Practice Location Address Fax Number:
81944870025
Provider Enumeration Date:
01/17/2017

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: 2085R0202X , with the licence number:  022675 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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