Daryl Tadashi Kubotsu, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA12055 Issued in CA

Practice address

7117 Brockton Ave
Riverside, CA 92506-2615

Phone

(951) 782-3853

Fax

(951) 784-3269

NPI assigned

Nov 23, 2005

Last updated

May 9, 2008By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210291200000",
    "number": "1558344465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 ARLINGTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063912",
            "telephone_number": "951-782-3853",
            "fax_number": "951-784-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7117 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062615",
            "telephone_number": "951-782-3853",
            "fax_number": "951-784-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBOTSU",
        "first_name": "DARYL",
        "middle_name": "TADASHI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2008-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA12055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI#",
            "identifier": "1730180415",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP SITE #",
            "identifier": "ZZZ318872",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph K Ku, MD
• Desiree Kua
• Genevieve Luu Kua, PHARMD
• Connie Kuang, PA-C
• Emily Kubaski
• Katarina Kucavikova-Fillippelli, MSW, ASW
• Sydney Kujawa
• Kevin Eugene Kumagai
• Grace Nozomi Kumamoto, MD
• Bangaruswamy V Kumar, MD

• Medical Physician Assistant in Riverside, CA
• Providers in Riverside, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.