Individual
MR. KAYNE K KISHIYAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1498 MIDWAY AVE, SUITE 2, AMMON, ID 83406-4587
(208) 552-0920
(208) 529-2564
Mailing address
1498 MIDWAY AVE, SUITE 2, AMMON, ID 83406-4587
(208) 552-0920
(208) 529-2564
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M-6638
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804042400
—
ID
Enumeration date
06/14/2006
Last updated
04/29/2013
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