Individual
DR. KEVIN TAKAO KODAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1187 E HERNDON AVE STE 101, FRESNO, CA 93720-3166
(559) 440-0450
(559) 440-0461
Mailing address
1187 E HERNDON AVE STE 101, FRESNO, CA 93720-3166
(559) 440-0450
(559) 440-0461
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G78832
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G788320
BLUE SHIELD
—
05
—
00G788320
—
CA
01
—
100014017
MEDICARE RAILROAD
—
Enumeration date
07/27/2006
Last updated
02/24/2009
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