Healthcare Provider Details

I. General information

NPI: 1720549686
Provider Name (Legal Business Name): AIRI KATOH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-6890
US

IV. Provider business mailing address

PO BOX 889442
LOS ANGELES CA
90088-9442
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA179739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: