Healthcare Provider Details

I. General information

NPI: 1073670675
Provider Name (Legal Business Name): JASON I TOKUMOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CAPP ST
SAN FRANCISCO CA
94110-1210
US

IV. Provider business mailing address

4143 20TH ST
SAN FRANCISCO CA
94114-2824
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-1170
  • Fax:
Mailing address:
  • Phone: 415-642-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberG64464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: