Healthcare Provider Details

I. General information

NPI: 1477001832
Provider Name (Legal Business Name): KENNETH HAJIME OYADOMARI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 ARTESIA BLVD STE 207
BELLFLOWER CA
90706-6769
US

IV. Provider business mailing address

PO BOX 3303
LA HABRA CA
90632-3303
US

V. Phone/Fax

Practice location:
  • Phone: 562-270-4100
  • Fax: 562-270-5600
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: