Provider Demographics
NPI:1295716090
Name:MORIWAKI, MARK MITSUYUKI (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:MITSUYUKI
Last Name:MORIWAKI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:SUITE G400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3730
Mailing Address - Fax:916-734-7953
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:SUITE G400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3730
Practice Address - Fax:916-734-7953
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-07-29
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Provider Licenses
StateLicense IDTaxonomies
CAG74752207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF83561Medicare UPIN