Healthcare Provider Details

I. General information

NPI: 1033363825
Provider Name (Legal Business Name): KENNTH TOKUTOMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ARCH ST
REDWOOD CITY CA
94062-1305
US

IV. Provider business mailing address

PO BOX 60004
SUNNYVALE CA
94088-0004
US

V. Phone/Fax

Practice location:
  • Phone: 165-055-6942
  • Fax:
Mailing address:
  • Phone: 140-820-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT6492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: