Provider Demographics
NPI:1306313085
Name:TSURUIKE, MASAAKI (PHD, ATC)
Entity type:Individual
Prefix:DR
First Name:MASAAKI
Middle Name:
Last Name:TSURUIKE
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 NORTHLAKE DR APT 58
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1385
Mailing Address - Country:US
Mailing Address - Phone:408-614-8046
Mailing Address - Fax:
Practice Address - Street 1:ONE WASHINGTON SQUARE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95192-0054
Practice Address - Country:US
Practice Address - Phone:408-924-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0295025572083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine