Provider Demographics
NPI:1265926661
Name:SONODA, KENTO (MD, AAHIVS)
Entity type:Individual
Prefix:
First Name:KENTO
Middle Name:
Last Name:SONODA
Suffix:
Gender:M
Credentials:MD, AAHIVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 S. SPRING AVE, SLUCARE ACADEMIC PAVILION
Mailing Address - Street 2:3RD FLOOR, FAMILY AND COMMUNITY MEDICINE
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-977-8480
Mailing Address - Fax:
Practice Address - Street 1:1225 S GRAND BLVD FL 2
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-617-2510
Practice Address - Fax:314-768-6605
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT216745207Q00000X
PAMD475598207Q00000X
MO2022007809207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine