Provider Demographics
NPI:1427189414
Name:KANEMARU, COZIE N (OD)
Entity Type:Individual
Prefix:
First Name:COZIE
Middle Name:N
Last Name:KANEMARU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22340 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2506
Mailing Address - Country:US
Mailing Address - Phone:310-791-0229
Mailing Address - Fax:
Practice Address - Street 1:22340 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2506
Practice Address - Country:US
Practice Address - Phone:310-791-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7973TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079731Medicaid
CASD0079731Medicaid
CAU34551Medicare UPIN