Provider Demographics
NPI:1679658280
Name:ISHIHARA, KENT KUNIO (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:KUNIO
Last Name:ISHIHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 V STREET, SUITE G400
Mailing Address - Street 2:UC DAVIS MEDICAL CENTER
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-3730
Mailing Address - Fax:
Practice Address - Street 1:4150 V STREET, SUITE G400
Practice Address - Street 2:UC DAVIS MEDICAL CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013491207RE0101X
CAA 106368207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism