Provider Demographics
NPI:1801837208
Name:IKEMIYASHIRO, DANIEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:IKEMIYASHIRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1140 OLIVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1210
Mailing Address - Country:US
Mailing Address - Phone:209-725-2121
Mailing Address - Fax:209-725-2123
Practice Address - Street 1:1140 OLIVEWOOD DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1210
Practice Address - Country:US
Practice Address - Phone:209-725-2121
Practice Address - Fax:209-725-2123
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54201207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082110Medicaid
CAGR0082110Medicaid
CA1801837208Medicare PIN