Healthcare Provider Details

I. General information

NPI: 1477383081
Provider Name (Legal Business Name): KEVIN OKUDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23001 DEL LAGO DR
LAGUNA HILLS CA
92653-1354
US

IV. Provider business mailing address

9 LA DERA
IRVINE CA
92620-1947
US

V. Phone/Fax

Practice location:
  • Phone: 949-387-7333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: