MEDICARE: MICHAEL KURISU D.O. A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1023481637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL KURISU D.O. A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	3706 RUFFIN RD
Second Line	:	SUITE 129
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1812
Country	:	US
Telephone Number	:	858-587-1822
Fax Number	:	858-587-8967

Provider Business Practice Location Address
First Line	:	3706 RUFFIN RD
Second Line	:	SUITE 129
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1812
Country	:	US
Telephone Number	:	858-587-1822
Fax Number	:	858-587-8967

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL KURISU
Credential	:	D.O.
Telephone Number	:	858-587-1822

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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