Healthcare Provider Details

I. General information

NPI: 1649743428
Provider Name (Legal Business Name): MIMI OKA C.S.B.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E 7TH ST PH 1
NEW YORK NY
10009-6087
US

IV. Provider business mailing address

259 E 7TH ST PH 1
NEW YORK NY
10009-6087
US

V. Phone/Fax

Practice location:
  • Phone: 212-358-1776
  • Fax:
Mailing address:
  • Phone: 212-358-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: