Healthcare Provider Details

I. General information

NPI: 1639822810
Provider Name (Legal Business Name): KEN OKADA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2587 MERCED ST
SAN LEANDRO CA
94577-4207
US

IV. Provider business mailing address

16100 BERTERO AVE
SAN LORENZO CA
94580-1124
US

V. Phone/Fax

Practice location:
  • Phone: 510-351-3553
  • Fax:
Mailing address:
  • Phone: 510-427-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number297226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: