MEDICARE: DR. CLARISSA AKIKO KIYOMURA OD

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	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1588599542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARISSA AKIKO KIYOMURA OD

Provider Business Mailing Address
First Line	:	925 CHEVRON CT
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-1029
Country	:	US
Telephone Number	:	626-437-0456
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 E 7TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90822-5201
Country	:	US
Telephone Number	:	844-808-2020
Fax Number	:

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

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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