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General NPI Number Information
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NPI Number | 1063610210
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Entity Type | Organization
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Legal Business Name | KENNETH ISHIZUE MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 1441 CONSTITUTION BLVD SUITE 200 ORTHOPEDICS CLINIC
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City | SALINAS
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State | CA
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Zip | 93906-3100
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Country | US
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Telephone | 831-755-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 12705 CORTE CORDILLERA
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City | SALINAS
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State | CA
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Zip | 93908-8942
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Country | US
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Telephone | 831-755-4299
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH K ISHIZUE
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Credential | M.D.
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Telephone | 831-755-4299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G56343
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License Number State | CA
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