Healthcare Provider Details

I. General information

NPI: 1902848369
Provider Name (Legal Business Name): DRS. KAMEI AND HATHAWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 PIONEER LN SUITE C
BISHOP CA
93514-2563
US

IV. Provider business mailing address

152 PIONEER LN SUITE C
BISHOP CA
93514-2563
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-7111
  • Fax:
Mailing address:
  • Phone: 760-873-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA79473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA79473
License Number StateCA

VIII. Authorized Official

Name: DR. ASAO KAMEI
Title or Position: PARTNER
Credential: MD
Phone: 760-873-7111