1881741254 NPI number — MRS. KIMBERLY LYNN HATSUMI OSHEROFF PT

Table of content: MRS. KIMBERLY LYNN HATSUMI OSHEROFF PT (NPI 1881741254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881741254 NPI number — MRS. KIMBERLY LYNN HATSUMI OSHEROFF PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSHEROFF
Provider First Name:
KIMBERLY
Provider Middle Name:
LYNN HATSUMI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAEDA
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
LYNN HATSUMI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881741254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
484 ESTADO WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-893-9285
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 REDWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NOVATO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-893-9285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2007

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: 225100000X , with the licence number:  PT20735 , 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)





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