Provider Demographics
NPI:1952979940
Name:KUNISAKI, KENNETH SATORU (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SATORU
Last Name:KUNISAKI
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N LAKE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5120
Mailing Address - Country:US
Mailing Address - Phone:626-568-9115
Mailing Address - Fax:616-568-9232
Practice Address - Street 1:301 N LAKE AVE STE 201
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5120
Practice Address - Country:US
Practice Address - Phone:626-568-9115
Practice Address - Fax:616-568-9232
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
20000226562255A2300X
CA300719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer