Provider Demographics
NPI:1134134828
Name:MURATA, KENNETH M (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:MURATA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 W 175TH PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3120
Mailing Address - Country:US
Mailing Address - Phone:310-371-8197
Mailing Address - Fax:
Practice Address - Street 1:4403 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2413
Practice Address - Country:US
Practice Address - Phone:323-232-1234
Practice Address - Fax:323-232-3789
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 4960 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0049600Medicaid
CAWOP4960BMedicare ID - Type Unspecified
CAU32023Medicare UPIN