Provider Demographics
NPI:1114205143
Name:OISHI, KENSUKE
Entity Type:Individual
Prefix:MR
First Name:KENSUKE
Middle Name:
Last Name:OISHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 THE VLG UNIT 107
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2543
Mailing Address - Country:US
Mailing Address - Phone:909-437-5886
Mailing Address - Fax:
Practice Address - Street 1:250 THE VLG UNIT 107
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2543
Practice Address - Country:US
Practice Address - Phone:909-437-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13016Medicaid
CA13016Medicare PIN