Healthcare Provider Details

I. General information

NPI: 1023125747
Provider Name (Legal Business Name): KENNETH YUKIO USUKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX-647
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-4096
  • Fax: 585-275-1531
Mailing address:
  • Phone: 585-275-5216
  • Fax: 585-275-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number255344
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: