Provider Demographics
NPI:1063527422
Name:ROBERT KIYOMURA MD PC
Entity type:Organization
Organization Name:ROBERT KIYOMURA MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SHIGERU
Authorized Official - Last Name:KIYOMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-773-9710
Mailing Address - Street 1:2084 ROBINS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1100
Mailing Address - Country:US
Mailing Address - Phone:801-773-9710
Mailing Address - Fax:801-773-9944
Practice Address - Street 1:2084 ROBINS DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1100
Practice Address - Country:US
Practice Address - Phone:801-773-9710
Practice Address - Fax:801-773-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT556683643005Medicaid