Provider Demographics
NPI:1821061599
Name:MIYAGAWA, DEAN K (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:K
Last Name:MIYAGAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:10085 DOUBLE R BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5860
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-8180
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11050891OtherCAQH
NV0020116710Medicaid
NV110193142OtherRAILROAD MEDICARE
NV110193142OtherRAILROAD MEDICARE
NV0020116710Medicaid