Basic Information
| Provider Information | |||||||||
| NPI: | 1790790178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASUI | ||||||||
| FirstName: | REI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4156 LETHRAM CT | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945882607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105011245 | ||||||||
| FaxNumber: | 9252016016 | ||||||||
| Practice Location | |||||||||
| Address1: | 4361 RAILROAD AVE | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945666611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252016028 | ||||||||
| FaxNumber: | 9252016023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 208000000X | A69220 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 208000000X | 01 | CA | TAXONOMY | OTHER |