Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A126416 | CA |
NPI | 1063774610 |
---|---|
Provider Name | Dr. Anne Kern Wakamiya |
First Address | Los Angeles, CA 90095-3000 |
Second Address | Stanford, CA 94305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2012 |
Last Update Date | 16/11/2017 |