Provider Demographics
NPI:1588163067
Name:MORISAKO, RANDEN KEKOA (ATC)
Entity type:Individual
Prefix:MR
First Name:RANDEN
Middle Name:KEKOA
Last Name:MORISAKO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ANHUA STREET
Mailing Address - Street 2:ACTIVITIES OFFICE
Mailing Address - City:BEIJING
Mailing Address - State:SHUNYI
Mailing Address - Zip Code:101318
Mailing Address - Country:CN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 ANHUA STREET
Practice Address - Street 2:ACTIVITIES OFFICE
Practice Address - City:BEIJING
Practice Address - State:SHUNYI
Practice Address - Zip Code:101318
Practice Address - Country:CN
Practice Address - Phone:108-149-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer