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Individual
DR. WALTER TAKESHI KUSUMOTO
Active
Individual
DR. WALTER TAKESHI KUSUMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D. M.P.H.
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
A60788
CA
207RI0011X
Interventional Cardiology Physician
A60788
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A607880
MEDI-CAL
CA
01
—
1619935079
NPI
—
01
—
A60788
MEDICAL BOARD OF CALIFORNIA - CALIFORNIA MEDICAL LICENSE
CA
01
—
BK5138169
DEA
CA
01
—
FNP 41401
MEDICAL BOARD OF CALIFORNIA--FICTICIOUS NAME PERMIT (FNP)
CA
Enumeration date
05/03/2006
Last updated
08/30/2023
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