Provider Demographics
NPI:1407110190
Name:KISHIYAMA, KAREN LAM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LAM
Last Name:KISHIYAMA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:680 W TENNYSON RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-5236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 S EL CAMINO REAL
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3047
Practice Address - Country:US
Practice Address - Phone:650-372-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619571223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry