Healthcare Provider Details

I. General information

NPI: 1144694134
Provider Name (Legal Business Name): KORI OKUDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 11/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 PENINSULA AVE
SAN MATEO CA
94401-1653
US

IV. Provider business mailing address

16810 ZINFANDEL CIR
MORGAN HILL CA
95037-7075
US

V. Phone/Fax

Practice location:
  • Phone: 650-286-4396
  • Fax:
Mailing address:
  • Phone: 650-207-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: