Provider Demographics
NPI:1912727710
Name:MIZUSHIMA, KAZUKO KIM
Entity type:Individual
Prefix:
First Name:KAZUKO
Middle Name:KIM
Last Name:MIZUSHIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 ALLOWAY ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2361
Mailing Address - Country:US
Mailing Address - Phone:310-666-2571
Mailing Address - Fax:
Practice Address - Street 1:515 13TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2437
Practice Address - Country:US
Practice Address - Phone:209-884-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician