Healthcare Provider Details

I. General information

NPI: 1548460058
Provider Name (Legal Business Name): MARK SCOTT OKUNO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12629 W WASHINGTON BLVD
LOS ANGELES CA
90066-2303
US

IV. Provider business mailing address

12629 W WASHINGTON BLVD
LOS ANGELES CA
90066-2303
US

V. Phone/Fax

Practice location:
  • Phone: 310-391-7116
  • Fax:
Mailing address:
  • Phone: 310-391-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number015007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: