Provider Demographics
NPI:1770540858
Name:MASAYASU KIHIRA MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MASAYASU KIHIRA MD A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTITIONER MEDICAL DIRECTO
Authorized Official - Prefix:DR
Authorized Official - First Name:MASAYASU
Authorized Official - Middle Name:
Authorized Official - Last Name:KIHIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:650-558-0337
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30019ZMedicare PIN
CAG18602Medicare UPIN