Provider Demographics
NPI:1770877615
Name:MIYASHIRO, JESSICA KIKUMI (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KIKUMI
Last Name:MIYASHIRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2100 POWELL ST
Mailing Address - Street 2:STE. 920
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1826
Mailing Address - Country:US
Mailing Address - Phone:510-350-2666
Mailing Address - Fax:510-879-4084
Practice Address - Street 1:7500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5403
Practice Address - Country:US
Practice Address - Phone:916-423-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2012-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA21512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant