Provider Demographics
NPI:1942516737
Name:B. MAYA KATO, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:B. MAYA KATO, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLYTHE
Authorized Official - Middle Name:MAYA
Authorized Official - Last Name:KATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-565-3900
Mailing Address - Street 1:36867 COOK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6064
Mailing Address - Country:US
Mailing Address - Phone:760-565-3900
Mailing Address - Fax:855-505-3900
Practice Address - Street 1:36867 COOK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6064
Practice Address - Country:US
Practice Address - Phone:760-565-3900
Practice Address - Fax:855-505-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86538207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
EA334AOtherPTAN
CA00G865380Medicaid
CAH96463Medicare UPIN
CA00G865380Medicare PIN