Provider Demographics
NPI:1902144603
Name:KRIS OKUMU MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KRIS OKUMU MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUMU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-735-2005
Mailing Address - Street 1:2490 HOSPITAL DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4117
Mailing Address - Country:US
Mailing Address - Phone:650-735-2005
Mailing Address - Fax:
Practice Address - Street 1:2490 HOSPITAL DR STE 106
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4117
Practice Address - Country:US
Practice Address - Phone:650-735-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
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