Healthcare Provider Details

I. General information

NPI: 1508446774
Provider Name (Legal Business Name): KODY KENSHIRO SUMIDA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7246
  • Fax:
Mailing address:
  • Phone: 808-227-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A24955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: