Provider Demographics
NPI:1154425536
Name:MIYAKAWA, JON Y (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:Y
Last Name:MIYAKAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274
Mailing Address - Country:US
Mailing Address - Phone:559-688-1992
Mailing Address - Fax:559-688-7767
Practice Address - Street 1:901 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274
Practice Address - Country:US
Practice Address - Phone:559-688-1992
Practice Address - Fax:559-688-7767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G519570Medicaid
A52130Medicare UPIN
CA00G519570Medicaid