Provider Demographics
NPI:1881744431
Name:KATO, MITSUAKI DAVID (OD)
Entity type:Individual
Prefix:
First Name:MITSUAKI
Middle Name:DAVID
Last Name:KATO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 W PICO BLVD
Mailing Address - Street 2:SPACE 199
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2130
Mailing Address - Country:US
Mailing Address - Phone:310-441-4286
Mailing Address - Fax:310-441-4289
Practice Address - Street 1:10800 W PICO BLVD
Practice Address - Street 2:SPACE 199
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2130
Practice Address - Country:US
Practice Address - Phone:310-441-4286
Practice Address - Fax:310-441-4289
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10896T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU68598Medicare UPIN
CAWOP10896Medicare ID - Type Unspecified