Provider Demographics
NPI:1477566040
Name:TOMIZAWA, TOMMY H (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:H
Last Name:TOMIZAWA
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 1:150 N. ROBERTSON BLVD.
Mailing Address - Street 2:SUITE #150
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-653-9356
Mailing Address - Fax:310-652-4053
Practice Address - Street 1:150 N. ROBERTSON BLVD.
Practice Address - Street 2:SUITE #150
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-653-9256
Practice Address - Fax:310-652-4053
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64986174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76582Medicare UPIN