Provider Demographics
NPI:1720164239
Name:OKUZUMI, GWENDOLYN C (MD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:C
Last Name:OKUZUMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CALIFORNIA ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5424
Mailing Address - Country:US
Mailing Address - Phone:415-504-3838
Mailing Address - Fax:415-504-1367
Practice Address - Street 1:1 CALIFORNIA ST STE 2300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5424
Practice Address - Country:US
Practice Address - Phone:415-504-3838
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT2033207Q00000X
FLME147618207Q00000X
IAMD-47866207Q00000X
CODR.0065122207Q00000X
HIMD-11656207Q00000X
NY307217207Q00000X
AZ61744207Q00000X
CAA76974207Q00000X
NMMD2020-1030207Q00000X
AK166659207Q00000X
ORMD201499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A769740Medicaid
00A769740Medicare ID - Type Unspecified
CA00A769740Medicaid