Healthcare Provider Details

I. General information

NPI: 1053528331
Provider Name (Legal Business Name): KENICHI TAMAMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST S417 BST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

200 LOTHROP ST S417 BST
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-1260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMD426992
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: