Provider Demographics
NPI:1750691580
Name:NEAL T. MIYASAKI, MD, APC
Entity type:Organization
Organization Name:NEAL T. MIYASAKI, MD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:MIYASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-387-7800
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:# 409
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-387-7800
Mailing Address - Fax:415-387-0743
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:# 409
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-387-7800
Practice Address - Fax:415-387-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27668261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G276680Medicaid
CA00G276680Medicare PIN
CAA43442Medicare UPIN