Provider Demographics
NPI:1003561507
Name:TSUBOSAKA, MASANORI (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MASANORI
Middle Name:
Last Name:TSUBOSAKA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5101
Mailing Address - Country:US
Mailing Address - Phone:650-723-7887
Mailing Address - Fax:650-725-1958
Practice Address - Street 1:269 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5101
Practice Address - Country:US
Practice Address - Phone:650-723-7887
Practice Address - Fax:650-725-1958
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program