Healthcare Provider Details

I. General information

NPI: 1124016506
Provider Name (Legal Business Name): DICK Y OKINO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S FREDERICK AVE STE 304
GAITHERSBURG MD
20877-1277
US

IV. Provider business mailing address

915 TOLL HOUSE AVE #207
FREDERICK MD
21701-5930
US

V. Phone/Fax

Practice location:
  • Phone: 240-477-4428
  • Fax: 306-663-0095
Mailing address:
  • Phone: 301-663-6861
  • Fax: 306-663-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01414
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: