Provider Demographics
NPI:1952857369
Name:OKUMU MD INC.
Entity Type:Organization
Organization Name:OKUMU MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUMU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-458-0794
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:STE 602
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2228
Mailing Address - Country:US
Mailing Address - Phone:408-458-0794
Mailing Address - Fax:408-358-8692
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:STE 602
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:408-458-0794
Practice Address - Fax:408-358-8692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92195207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty