Individual
BOB KYO MIYAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2485 W HORIZON RIDGE PKWY, SUITE 100, HENDERSON, NV 89052-5948
(702) 212-5889
(702) 212-5890
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
15295
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V108863
MEDICARE PTAN
NV
Enumeration date
08/29/2006
Last updated
10/30/2023
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