Provider Demographics
NPI:1871648121
Name:MORINISHI, GLENN KAZUO (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:KAZUO
Last Name:MORINISHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 N EUCLID ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4122
Mailing Address - Country:US
Mailing Address - Phone:714-517-2100
Mailing Address - Fax:714-300-0473
Practice Address - Street 1:710 N EUCLID ST STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4132
Practice Address - Country:US
Practice Address - Phone:714-772-1030
Practice Address - Fax:714-772-1758
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750436473OtherNPI
CA1750436473OtherNPI