Provider Demographics
NPI:1508108622
Name:SUGIURA, KONOSUKE (LAC)
Entity Type:Individual
Prefix:MR
First Name:KONOSUKE
Middle Name:
Last Name:SUGIURA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23805 ARLINGTON AVE
Mailing Address - Street 2:APT.#29
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-6155
Mailing Address - Country:US
Mailing Address - Phone:310-600-4802
Mailing Address - Fax:310-539-4816
Practice Address - Street 1:24241 HAWTHORNE BLVD.,
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-600-4802
Practice Address - Fax:310-539-4816
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14365171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist