Provider Demographics
NPI:1689696411
Name:KIRA, DAVID TAKESHI (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TAKESHI
Last Name:KIRA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1700 ALHAMBRA BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-731-8040
Mailing Address - Fax:916-454-4152
Practice Address - Street 1:635 ANDERSON RD
Practice Address - Street 2:STE 1
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-756-5040
Practice Address - Fax:530-756-9140
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-11-05
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Provider Licenses
StateLicense IDTaxonomies
CAA77637207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0042241Medicaid
CAZZZ23744ZMedicare ID - Type Unspecified
I04904Medicare UPIN