Provider Demographics
NPI:1013463488
Name:KURAOKA CLINIC TEXAS, PLLC
Entity type:Organization
Organization Name:KURAOKA CLINIC TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEAUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-980-0000
Mailing Address - Street 1:100 GALLERIA PKWY SE STE 660
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5912
Mailing Address - Country:US
Mailing Address - Phone:770-980-0000
Mailing Address - Fax:
Practice Address - Street 1:3012 E HEBRON PKWY STE 104
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4461
Practice Address - Country:US
Practice Address - Phone:972-306-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8334261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care