Healthcare Provider Details

I. General information

NPI: 1225433469
Provider Name (Legal Business Name): KATHERINE SANTOHIGASHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ZONAL AVE ROOM 112
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

2010 ZONAL AVE # 3P61
LOS ANGELES CA
90033-1026
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA136197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: