Provider Demographics
NPI:1235178021
Name:OKAMOTO, THOMAS HIROSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HIROSHI
Last Name:OKAMOTO
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 1:2130 E 4TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3818
Mailing Address - Country:US
Mailing Address - Phone:714-558-2460
Mailing Address - Fax:714-972-0275
Practice Address - Street 1:2130 E 4TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3818
Practice Address - Country:US
Practice Address - Phone:714-558-2460
Practice Address - Fax:714-972-0275
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG481642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92793Medicare UPIN