Provider Demographics
NPI:1205906740
Name:KURATA, FRED KAZUHIRO (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:KAZUHIRO
Last Name:KURATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 3RD ST
Mailing Address - Street 2:STE 603
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1645
Mailing Address - Country:US
Mailing Address - Phone:213-680-1551
Mailing Address - Fax:213-680-2148
Practice Address - Street 1:420 E 3RD ST
Practice Address - Street 2:STE 603
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1645
Practice Address - Country:US
Practice Address - Phone:213-680-1551
Practice Address - Fax:213-680-2148
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49917174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078580Medicaid
CAGR0078583Medicaid
CA00G499170Medicaid
CAGR0078581Medicaid
CAGR0078582Medicaid
CAW13961BMedicare ID - Type UnspecifiedGROUP NUMBER
CAGR0078582Medicaid
CA1176620003Medicare NSC
CA1176620001Medicare NSC
CAGR0078581Medicaid
CAA92942Medicare UPIN
CAGR0078580Medicaid
CAW13961AMedicare ID - Type UnspecifiedGROUP NUMBER
CAWG49917FMedicare ID - Type UnspecifiedINDIVIDUAL
CAWG49917EMedicare ID - Type UnspecifiedINDIVIDUAL
CA1176620004Medicare NSC
CAWG49917DMedicare ID - Type Unspecified
CA1176620002Medicare NSC