Individual
JERRY KIYOHARU WADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1505 WILSON TER STE 200, GLENDALE, CA 91206-4073
(818) 409-0105
(818) 409-0151
Mailing address
541 W COLORADO ST STE 205, GLENDALE, CA 91204-3640
(323) 254-0046
(323) 488-9782
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
G22808
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G228080
—
CA
01
—
G22808
CA MEDICAL LICENSE
CA
Enumeration date
08/30/2006
Last updated
03/12/2021
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