Provider Demographics
NPI:1336175561
Name:KUSUDA, MISAO (MD)
Entity type:Individual
Prefix:
First Name:MISAO
Middle Name:
Last Name:KUSUDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20863 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 580
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2113
Mailing Address - Country:US
Mailing Address - Phone:408-930-2256
Mailing Address - Fax:
Practice Address - Street 1:20863 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 580
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2113
Practice Address - Country:US
Practice Address - Phone:408-930-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2012-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG466702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry