Provider Demographics
NPI:1063903540
Name:KANEKO, TSUNEO
Entity type:Individual
Prefix:
First Name:TSUNEO
Middle Name:
Last Name:KANEKO
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 1:620 HAVERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4310
Mailing Address - Country:US
Mailing Address - Phone:310-459-7239
Mailing Address - Fax:
Practice Address - Street 1:1460 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2329
Practice Address - Country:US
Practice Address - Phone:310-319-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1198171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC1198OtherHEALTH INSURANCE
CACA1198OtherHEALTH INSURANCE