Healthcare Provider Details

I. General information

NPI: 1679736300
Provider Name (Legal Business Name): KRIS OKUMU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 MAIN ST
WATSONVILLE CA
95076-3092
US

IV. Provider business mailing address

65 NEILSON ST STE 102
WATSONVILLE CA
95076-2491
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-4227
  • Fax: 831-728-0410
Mailing address:
  • Phone: 831-768-6217
  • Fax: 831-768-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA92195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: