Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G86538 | CA |
NPI | 1003991761 |
---|---|
Provider Name | B. Maya Kato |
First Address | Palm Desert, CA 92211-6064 |
Second Address | Palm Desert, CA 92211-6064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G865380 | (05) | CA |
CO622Y | PTAN (01) | |
H96463 | (02) | |
H96463 | (02) | CA |