Healthcare Provider Details

I. General information

NPI: 1255089363
Provider Name (Legal Business Name): MARK MORISHIGE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 ALTOS OAKS DR STE 2
LOS ALTOS CA
94024-5400
US

IV. Provider business mailing address

763 ALTOS OAKS DR STE 2
LOS ALTOS CA
94024-5400
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-0444
  • Fax: 408-358-5125
Mailing address:
  • Phone: 408-356-0444
  • Fax: 408-358-5125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK MORISHIGE
Title or Position: DR
Credential: MD
Phone: 408-356-0444