Provider Demographics
NPI:1689814964
Name:UTSUMI, KAYOMI (DC LAC)
Entity Type:Individual
Prefix:DR
First Name:KAYOMI
Middle Name:
Last Name:UTSUMI
Suffix:
Gender:F
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4705
Mailing Address - Country:US
Mailing Address - Phone:209-533-5382
Mailing Address - Fax:209-533-5382
Practice Address - Street 1:51 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4705
Practice Address - Country:US
Practice Address - Phone:209-533-5382
Practice Address - Fax:209-533-5382
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12708171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist