Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | MD00048081 | WA |
NPI | 1477609147 |
---|---|
Provider Name | Dr. Christopher Kishiyama |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 16/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8486797 | (05) | WA |
AB32999 | MEDICARE GROUP (01) | WA |