Healthcare Provider Details

I. General information

NPI: 1770540858
Provider Name (Legal Business Name): MASAYASU KIHIRA MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N SAN MATEO DR NIHON BAY CLINIC
SAN MATEO CA
94401-2824
US

IV. Provider business mailing address

40 N SAN MATEO DR NIHON BAY CLINIC
SAN MATEO CA
94401-2824
US

V. Phone/Fax

Practice location:
  • Phone: 650-558-0337
  • Fax: 650-558-9364
Mailing address:
  • Phone: 650-558-0337
  • Fax: 650-558-9364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MASAYASU KIHIRA
Title or Position: FAMILY PRACTITIONER MEDICAL DIRECTO
Credential: MD PHD
Phone: 650-558-0337