Organization
KENICHI T. MIYATA MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENICHI T MIYATA MD (SURGEON)
(209) 580-4866
Entity
Organization
Contact information
Practice address
700 W OLIVE AVE STE F, MERCED, CA 95348-2435
(209) 580-4866
(209) 580-4861
Mailing address
700 W OLIVE AVE STE F, MERCED, CA 95348-2435
(209) 580-4866
(209) 580-4861
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A117496
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A117496
MEDICAL LICENSE
CA
Enumeration date
04/15/2013
Last updated
04/24/2024
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