Provider Demographics
NPI:1811501018
Name:FRISCH, KASUMI
Entity type:Individual
Prefix:
First Name:KASUMI
Middle Name:
Last Name:FRISCH
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 1:9150 CHESAPEAKE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1097
Mailing Address - Country:US
Mailing Address - Phone:619-542-0884
Mailing Address - Fax:
Practice Address - Street 1:5240 N SHERIDAN RD APT 910
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2598
Practice Address - Country:US
Practice Address - Phone:415-613-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227020729225700000X
CA64575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist