Provider Demographics
NPI:1710198627
Name:MIZUGUCHI, TOMOJI (MD)
Entity Type:Individual
Prefix:
First Name:TOMOJI
Middle Name:
Last Name:MIZUGUCHI
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 1:4290 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3562
Mailing Address - Country:US
Mailing Address - Phone:562-493-4499
Mailing Address - Fax:562-493-6512
Practice Address - Street 1:4290 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3562
Practice Address - Country:US
Practice Address - Phone:562-493-4499
Practice Address - Fax:562-493-6512
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31654207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFQ665AMedicare PIN