Healthcare Provider Details

I. General information

NPI: 1811501018
Provider Name (Legal Business Name): KASUMI FRISCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 N SHERIDAN RD APT 910
CHICAGO IL
60640-2598
US

IV. Provider business mailing address

9150 CHESAPEAKE DR STE 120
SAN DIEGO CA
92123-1097
US

V. Phone/Fax

Practice location:
  • Phone: 415-613-4262
  • Fax:
Mailing address:
  • Phone: 619-542-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227020729
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number64575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: