1851403828 NPI number — YAYA KISHIYAMA SU M.D.

Table of content: YAYA KISHIYAMA SU M.D. (NPI 1851403828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851403828 NPI number — YAYA KISHIYAMA SU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SU
Provider First Name:
YAYA
Provider Middle Name:
KISHIYAMA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ODY
Provider Other First Name:
YAYA
Provider Other Middle Name:
KISHIYAMA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851403828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6501 E GREENWAY PKWY
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85254-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-948-9903
Provider Business Mailing Address Fax Number:
480-998-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6501 E GREENWAY PKWY
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85254-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-948-9903
Provider Business Practice Location Address Fax Number:
480-998-5887
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35915 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0921700 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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