Provider Demographics
NPI:1649927518
Name:MORINO-MIRENDA, KANAKO
Entity type:Individual
Prefix:
First Name:KANAKO
Middle Name:
Last Name:MORINO-MIRENDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 8TH AVE APT 13J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4812
Mailing Address - Country:US
Mailing Address - Phone:917-687-2912
Mailing Address - Fax:
Practice Address - Street 1:2 W 45TH ST STE 1600
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4229
Practice Address - Country:US
Practice Address - Phone:917-388-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006918171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist