Kellen Matsuno, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

766 Saint Clair St
Costa Mesa, CA 92626-4314

Phone

(206) 999-9153

NPI assigned

Aug 23, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Physical Therapy and Performance, Inc

  • Physical Therapy Clinic/Center
  • Costa Mesa, CA
  • NPI 1801630074
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712361600000",
    "number": "1124509542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4139 E 11TH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908044255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "766 SAINT CLAIR ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264314",
            "telephone_number": "206-999-9153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATSUNO",
        "first_name": "KELLEN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-23",
        "last_updated": "2024-04-06",
        "certification_date": "2024-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Mathis
• Mary Grace Matin, FNP-C
• Maximiliano H Matos, M.D.
• Matrix Rehabilitation, Inc.
• Jasmine Matsumoto
• Matt G. Farzin DDS, Inc
• Matthew M. DO. DPM a Proffesional Corporation
• Miesha Patrice Matthews
• Lucina Antonia Mattila
• Xavier Joshua Matus

• Physical Therapist in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.