Healthcare Provider Details

I. General information

NPI: 1356502553
Provider Name (Legal Business Name): KRISTEN P TAMURA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N JACKSON AVE STE 103
SAN JOSE CA
95116-1909
US

IV. Provider business mailing address

85 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-1600
  • Fax: 408-604-0173
Mailing address:
  • Phone: 808-442-5700
  • Fax: 855-827-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA114723
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD19906
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: