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General NPI Number Information
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NPI Number | 1275709404
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Entity Type | Individual
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Provider Name | KENGO UEDA N.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 60 LAFAYETTE ST
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City | BRIDGEPORT
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State | CT
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Zip | 06604-5719
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Country | US
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Telephone | 203-576-4298
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Fax | 203-576-4128
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Provider Business Mailing Address
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Address Line | 765 GARFIELD AVE
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5254
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Country | US
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Telephone | 203-330-8375
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Fax | 203-330-8375
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 000385
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License Number State | CT
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