Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301091842 | MI |
N | 208600000X | Surgeon | 4301091842 | MI |
Y | 2086S0120X | Pediatric Surgery | A123051 | CA |
NPI | 1538319959 |
---|---|
Provider Name | Shin Miyata |
First Address | Los Angeles, CA 90010-2814 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2008 |
Last Update Date | 08/03/2017 |