Provider Demographics
NPI:1952091795
Name:MORIMITSU, KENJI
Entity Type:Individual
Prefix:MR
First Name:KENJI
Middle Name:
Last Name:MORIMITSU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18209 SIERRA HWY UNIT 25
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4396
Mailing Address - Country:US
Mailing Address - Phone:661-877-7312
Mailing Address - Fax:
Practice Address - Street 1:18209 SIERRA HWY UNIT 25
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-4396
Practice Address - Country:US
Practice Address - Phone:661-877-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist