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General NPI Number Information
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NPI Number | 1639713019
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Entity Type | Individual
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Provider Name | KAZUYUKI MATSUOKA LD
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Gender | Male
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 160 NE 6TH ST
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City | NEWPORT
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State | OR
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Zip | 97365-3131
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Country | US
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Telephone | 451-265-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 22524 SW 96TH DR
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City | TUALATIN
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State | OR
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Zip | 97062-7398
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Country | US
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Telephone | 408-621-4747
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Fax |
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | DT-DO-10197097
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License Number State | OR
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