Provider Demographics
NPI:1619924933
Name:KAIURA, TERRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:KAIURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:921 OAK PARK BLVD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3264
Mailing Address - Country:US
Mailing Address - Phone:805-489-8286
Mailing Address - Fax:805-489-7376
Practice Address - Street 1:921 OAK PARK BLVD
Practice Address - Street 2:SUITE 201B
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3264
Practice Address - Country:US
Practice Address - Phone:805-489-8286
Practice Address - Fax:805-489-7376
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78273207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB224594Medicare PIN
NY440A61Medicare PIN