| Kayne Kishiyama Md Pa | |
|
1522 Elk Creek Dr Idaho Falls ID 83404-8322 | |
| (208) 552-0920 | |
| (208) 529-2564 |
| Full Name | Kayne Kishiyama Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1522 Elk Creek Dr, Idaho Falls, Idaho |
| Authorized Official Name and Position | Kayne K Kishiyama (OWNER) |
| Authorized Official Contact | 2085520920 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kayne Kishiyama Md Pa 1522 Elk Creek Dr Idaho Falls ID 83404-8322 Ph: (208) 552-0920 | Kayne Kishiyama Md Pa 1522 Elk Creek Dr Idaho Falls ID 83404-8322 Ph: (208) 552-0920 |
| NPI Number | 1457518110 |
|---|---|
| Provider Enumeration Date | 05/20/2008 |
| Last Update Date | 05/20/2008 |
| Medicare PECOS PAC ID | 5395894034 |
|---|---|
| Medicare Enrollment ID | O20090528000548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457518110 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Kayne K Kishiyama |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568405405 PECOS PAC ID: 7618935271 Enrollment ID: I20041229000326 |
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