Healthcare Provider Details

I. General information

NPI: 1033513635
Provider Name (Legal Business Name): MICHIKO KAYAHARA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5451 LA PALMA AVE STE 47
LA PALMA CA
90623-1732
US

IV. Provider business mailing address

5569 CRESCENT AVE
CYPRESS CA
90630
US

V. Phone/Fax

Practice location:
  • Phone: 714-562-8560
  • Fax:
Mailing address:
  • Phone: 714-686-3867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number731110
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number731110
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number731110
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number731110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: