Provider Demographics
NPI:1477001832
Name:OYADOMARI, KENNETH HAJIME (PA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:HAJIME
Last Name:OYADOMARI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3303
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-3303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10230 ARTESIA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6769
Practice Address - Country:US
Practice Address - Phone:562-270-4100
Practice Address - Fax:562-270-5600
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant