Provider Demographics
NPI:1144220815
Name:MATSUDA, GEORGE TOSHINORI (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:TOSHINORI
Last Name:MATSUDA
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 1:10 CONGRESS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3023
Mailing Address - Country:US
Mailing Address - Phone:626-449-6223
Mailing Address - Fax:626-449-0035
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3023
Practice Address - Country:US
Practice Address - Phone:626-449-6223
Practice Address - Fax:626-449-0035
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67305207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F35492Medicare UPIN