Provider Demographics
NPI:1376343079
Name:ORTHOSPINE SPECIALISTS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ORTHOSPINE SPECIALISTS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUMU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-204-6495
Mailing Address - Street 1:56B 5TH ST UNIT 3892
Mailing Address - Street 2:
Mailing Address - City:CARMEL BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:93921-8181
Mailing Address - Country:US
Mailing Address - Phone:831-204-6495
Mailing Address - Fax:
Practice Address - Street 1:2400 SAMARITAN DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3910
Practice Address - Country:US
Practice Address - Phone:831-204-6495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty