Healthcare Provider Details

I. General information

NPI: 1497899918
Provider Name (Legal Business Name): KENNETH KATSUMI OHASHI L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 NATIONAL BLVD STE 607
LOS ANGELES CA
90064-4126
US

IV. Provider business mailing address

10757 GALVIN ST
CULVER CITY CA
90230-5406
US

V. Phone/Fax

Practice location:
  • Phone: 310-384-3111
  • Fax: 310-446-5323
Mailing address:
  • Phone: 310-384-3111
  • Fax: 310-446-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number9457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: