Provider Demographics
NPI:1851358071
Name:KIHIRA, MASAYASU (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MASAYASU
Middle Name:
Last Name:KIHIRA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N SAN MATEO DR
Mailing Address - Street 2:NIHON BAY CLINIC
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2824
Mailing Address - Country:US
Mailing Address - Phone:650-558-0337
Mailing Address - Fax:650-558-9364
Practice Address - Street 1:40 N SAN MATEO DR
Practice Address - Street 2:NIHON BAY CLINIC
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2824
Practice Address - Country:US
Practice Address - Phone:650-558-0337
Practice Address - Fax:650-558-9364
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061938207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ30019ZMedicare ID - Type Unspecified
G18602Medicare UPIN