MEDICARE: KATHARINE A KISHIYAMA MD

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	2086S0102X	Surgical Critical Care Physician	A163919	CA
2	208600000X	Surgery Physician	A163919	CA

General Provider Information

NPI Number	:	1760829600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE A KISHIYAMA MD

Provider Business Mailing Address
First Line	:	953 CLAYTON ST APT 5
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-4425
Country	:	US
Telephone Number	:	703-402-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 SULLIVAN AVE
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2229
Country	:	US
Telephone Number	:	650-992-4000
Fax Number	:

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

Provider Enumeration Date	:	06/02/2013
Last Update Date	:	03/15/2021

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