Provider Demographics
NPI:1205114477
Name:MIYATA, KANA
Entity type:Individual
Prefix:
First Name:KANA
Middle Name:
Last Name:MIYATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANA
Other - Middle Name:
Other - Last Name:NOSHIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1008 S. SPRING AVE.
Mailing Address - Street 2:SLUCARE ACADEMIC PAVILION, ROOM 2412, NEPHROLOGY
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-977-2650
Mailing Address - Fax:
Practice Address - Street 1:1008 S. SPRING AVE.
Practice Address - Street 2:SLUCARE ACADEMIC PAVILION, ROOM 2412, NEPHROLOGY
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-977-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127779207RN0300X
MO2020016492207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology