Basic Information
| Provider Information | |||||||||
| NPI: | 1760815401 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | IMAI | ||||||||
| FirstName: | MASAMI | ||||||||
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| Credential: | CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 P ST | ||||||||
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| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958146232 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 812 AVIS DR | ||||||||
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| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481089649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006387564 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2013 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | 1152 | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.