Provider Demographics
NPI:1699119636
Name:KANZAKI, KEIKO (NP)
Entity type:Individual
Prefix:
First Name:KEIKO
Middle Name:
Last Name:KANZAKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 STEVER ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5464
Mailing Address - Country:US
Mailing Address - Phone:310-714-9821
Mailing Address - Fax:310-837-0684
Practice Address - Street 1:10850 STEVER ST
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5464
Practice Address - Country:US
Practice Address - Phone:310-714-9821
Practice Address - Fax:310-837-0684
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily