Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 14222 | OK |
N | 2080P0210X | Pediatric Nephrologist | 14222 | OK |
NPI | 1780780437 |
---|---|
Provider Name | Dr. Roy Kiyoharu Teramoto |
First Address | Pasadena, CA 91110-0698 |
Second Address | Phoenix, AZ 85016-5319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 25/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
406993 | (05) | AZ |
AZ0713430 | BCBSAZ (01) | AZ |
D47098 | (02) | AZ |