Provider Demographics
NPI:1891208146
Name:OZAKI, KEVIN KIYOSHI (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:KIYOSHI
Last Name:OZAKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6732 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3721
Mailing Address - Country:US
Mailing Address - Phone:310-709-6674
Mailing Address - Fax:
Practice Address - Street 1:6732 W 87TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3721
Practice Address - Country:US
Practice Address - Phone:310-709-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist