Wada, Jerry Kiyoharu

Wada, Jerry Kiyoharu is an individual health care provider with primary practice located at 1505 Wilson Ter Ste 200 , Glendale CA 91206-4073. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hematology & Oncology, which is considered as his primary health care specialty. Wada, Jerry Kiyoharu can be contacted via phone (818) 409-0105.

Contact Information

Primary practice address
1505 Wilson Ter Ste 200 Glendale CA 91206-4073
Phone: (818) 409-0105
Fax: (818) 409-0151
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X G22808 California

Profile Details

NPI number 1487764379
LBN Legal business name Wada, Jerry Kiyoharu
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2006
Last updated Mar 12th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487764379 NPPES
California MEDICAID 00G228080
California Other G22808

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