Provider Demographics
NPI:1023481637
Name:MICHAEL KURISU D.O. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL KURISU D.O. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KURISU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:858-587-1822
Mailing Address - Street 1:3706 RUFFIN RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1812
Mailing Address - Country:US
Mailing Address - Phone:858-587-1822
Mailing Address - Fax:858-587-8967
Practice Address - Street 1:3706 RUFFIN RD
Practice Address - Street 2:SUITE 129
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1812
Practice Address - Country:US
Practice Address - Phone:858-587-1822
Practice Address - Fax:858-587-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI51027Medicare UPIN