Provider Demographics
NPI:1710460373
Name:UYENO, ROY KENJI (PA-C)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:KENJI
Last Name:UYENO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 PROVIDENCE DR STE 528
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4608
Mailing Address - Country:US
Mailing Address - Phone:907-770-7213
Mailing Address - Fax:907-770-7214
Practice Address - Street 1:3260 PROVIDENCE DR STE 528
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4608
Practice Address - Country:US
Practice Address - Phone:907-770-7213
Practice Address - Fax:907-770-7214
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK152286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program