Provider Demographics
NPI:1790502227
Name:MATSUYAMA, KAY JAMES (HIS)
Entity type:Individual
Prefix:MR
First Name:KAY
Middle Name:JAMES
Last Name:MATSUYAMA
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 FRANKLIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2716
Mailing Address - Country:US
Mailing Address - Phone:770-377-2974
Mailing Address - Fax:
Practice Address - Street 1:433 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1348
Practice Address - Country:US
Practice Address - Phone:626-939-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8987237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist