MEDICARE: MS. KARI EMILY MIYAMOTO FNP-C

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	363LF0000X	Family Nurse Practitioner	95017363	CA

General Provider Information

NPI Number	:	1275244840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARI EMILY MIYAMOTO FNP-C

Provider Business Mailing Address
First Line	:	1417 ARMACOST AVE APT 11
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11924 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5004
Country	:	US
Telephone Number	:	310-442-9588
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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