Provider Demographics
NPI:1578953956
Name:MORI, SHUSUKE
Entity Type:Individual
Prefix:
First Name:SHUSUKE
Middle Name:
Last Name:MORI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1-5-45 YUSHIMA
Mailing Address - Street 2:
Mailing Address - City:BUNKYO
Mailing Address - State:TOKYO
Mailing Address - Zip Code:1130034
Mailing Address - Country:JP
Mailing Address - Phone:033-813-6111
Mailing Address - Fax:
Practice Address - Street 1:1-5-45 YUSHIMA
Practice Address - Street 2:
Practice Address - City:BUNKYO
Practice Address - State:TOKYO
Practice Address - Zip Code:1130034
Practice Address - Country:JP
Practice Address - Phone:033-813-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital