Provider Demographics
NPI:1912993627
Name:WATANABE, AILEEN NAGAKO (MD)
Entity Type:Individual
Prefix:DR
First Name:AILEEN
Middle Name:NAGAKO
Last Name:WATANABE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2186 GEARY BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3455
Mailing Address - Country:US
Mailing Address - Phone:415-292-3500
Mailing Address - Fax:415-292-7500
Practice Address - Street 1:2186 GEARY BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3455
Practice Address - Country:US
Practice Address - Phone:415-292-3500
Practice Address - Fax:415-292-7500
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG52863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G528630Medicaid
CA00G528630Medicare ID - Type Unspecified
A52372Medicare UPIN