Provider Demographics
NPI:1932796422
Name:KERN, ERIKO YUTANI (PA)
Entity Type:Individual
Prefix:
First Name:ERIKO
Middle Name:YUTANI
Last Name:KERN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 CRETAN BLUE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7470
Mailing Address - Country:US
Mailing Address - Phone:702-408-5785
Mailing Address - Fax:
Practice Address - Street 1:3900 W CHARLESTON BLVD STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1682
Practice Address - Country:US
Practice Address - Phone:702-362-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNA207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine