Provider Demographics
NPI:1134229842
Name:MATSUDA, KAZUKO TRACI (MD)
Entity type:Individual
Prefix:DR
First Name:KAZUKO
Middle Name:TRACI
Last Name:MATSUDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2896
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-7896
Mailing Address - Country:US
Mailing Address - Phone:310-498-3450
Mailing Address - Fax:310-456-7592
Practice Address - Street 1:2665 30TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3063
Practice Address - Country:US
Practice Address - Phone:310-396-4558
Practice Address - Fax:310-396-4598
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 506392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry