Provider Demographics
NPI:1104362029
Name:KUDO, SHO (MD)
Entity Type:Individual
Prefix:
First Name:SHO
Middle Name:
Last Name:KUDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5-7-62 OOTAKARA
Mailing Address - Street 2:
Mailing Address - City:SAGA
Mailing Address - State:SAGA
Mailing Address - Zip Code:8400811
Mailing Address - Country:JP
Mailing Address - Phone:8195-228-7263
Mailing Address - Fax:8195-228-7263
Practice Address - Street 1:141-11 SAKEMI
Practice Address - Street 2:TAKAGI HOSPITAL
Practice Address - City:OKAWA
Practice Address - State:FUKUOKA
Practice Address - Zip Code:8310016
Practice Address - Country:JP
Practice Address - Phone:8194-487-0001
Practice Address - Fax:8194-487-0025
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0226752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology