Healthcare Provider Details

I. General information

NPI: 1679658280
Provider Name (Legal Business Name): KENT KUNIO ISHIHARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V STREET, SUITE G400 UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817
US

IV. Provider business mailing address

4150 V STREET, SUITE G400 UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3730
  • Fax:
Mailing address:
  • Phone: 916-734-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2005013491
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA 106368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: