MEDICARE: KYLE KATAYAMA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA67403	CA

General Provider Information

NPI Number	:	1194595538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE KATAYAMA PA

Provider Business Mailing Address
First Line	:	14650 AVIATION BLVD STE 200
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-6670
Country	:	US
Telephone Number	:	323-306-9632
Fax Number	:	323-268-6738

Provider Business Practice Location Address
First Line	:	1045 ATLANTIC AVE STE 505
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3422
Country	:	US
Telephone Number	:	323-306-9632
Fax Number	:	323-268-6738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	12/30/2025

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Directions to “ KYLE KATAYAMA PA” Practice Location

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