Provider Demographics
NPI:1811060445
Name:HISAMUNE, CHRISTIAN TOSHIO (PT)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:TOSHIO
Last Name:HISAMUNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10474 SANTA MONICA BLVD
Mailing Address - Street 2:STE 435
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6932
Mailing Address - Country:US
Mailing Address - Phone:310-869-9012
Mailing Address - Fax:
Practice Address - Street 1:10474 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 435
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6929
Practice Address - Country:US
Practice Address - Phone:310-275-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT12088AOtherPERFORMING PROVIDER IDENT
P39289Medicare UPIN