Provider Demographics
NPI:1477641686
Name:MYERS, TAMAKI A (MD)
Entity Type:Individual
Prefix:
First Name:TAMAKI
Middle Name:A
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMAKI
Other - Middle Name:A
Other - Last Name:KIMBRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2107 LIVINGSTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5218
Mailing Address - Country:US
Mailing Address - Phone:510-436-9000
Mailing Address - Fax:510-436-9013
Practice Address - Street 1:700 RIVER DR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5403
Practice Address - Country:US
Practice Address - Phone:707-961-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66863207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH70402Medicare UPIN