Provider Demographics
NPI:1003991761
Name:KATO, B. MAYA (MD)
Entity Type:Individual
Prefix:
First Name:B.
Middle Name:MAYA
Last Name:KATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36867 COOK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6064
Mailing Address - Country:US
Mailing Address - Phone:760-565-3900
Mailing Address - Fax:855-505-3900
Practice Address - Street 1:36867 COOK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6064
Practice Address - Country:US
Practice Address - Phone:760-565-3900
Practice Address - Fax:855-505-3900
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG86538207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G865380Medicaid
CO622YOtherPTAN
CA00G865380Medicare PIN
H96463Medicare UPIN
CO622YOtherPTAN