Healthcare Provider Details

I. General information

NPI: 1003062530
Provider Name (Legal Business Name): ROBERTA MIYEKO KATO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

6340 W. SUNSET BLVD STE 600
LOS ANGELES CA
90028-7901
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2101
  • Fax: 323-361-1355
Mailing address:
  • Phone: 323-361-2336
  • Fax: 323-644-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA95174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: