Healthcare Provider Details

I. General information

NPI: 1962954792
Provider Name (Legal Business Name): MITSUAKI DAVID KATO, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SEPULVEDA BLVD STE 1680
CULVER CITY CA
90230-6429
US

IV. Provider business mailing address

12040 HAMMACK ST
CULVER CITY CA
90230-5922
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-2142
  • Fax: 310-397-5306
Mailing address:
  • Phone: 310-266-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10896T
License Number StateCA

VIII. Authorized Official

Name: DR. MITSUAKI DAVID KATO
Title or Position: CEO
Credential: O.D.
Phone: 310-266-3155