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General NPI Number Information
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NPI Number | 1598108045
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Entity Type | Organization
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Legal Business Name | KENICHI T. MIYATA MD INC
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 700 W OLIVE AVE STE F
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City | MERCED
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State | CA
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Zip | 95348-2435
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Country | US
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Telephone | 209-580-4866
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Fax | 209-580-4861
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Provider Business Mailing Address
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Address Line | 700 W OLIVE AVE STE F
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City | MERCED
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State | CA
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Zip | 95348-2435
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Country | US
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Telephone | 209-580-4866
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Fax | 209-580-4861
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Authorized Official
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Title or Position | SURGEON
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Name | DR. KENICHI T MIYATA
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Credential | MD
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Telephone | 209-580-4866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A117496
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License Number State | CA
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