Linda Kajlsa Miyatake, DDS MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

37567 Issued in CA

Practice address

130 North San Mateo Drive
Suite 1
San Mateo, CA 94401

Phone

(650) 347-7014

Fax

(650) 347-5229

NPI assigned

Jan 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 22, 2013 through Apr 22, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346394764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 NORTH SAN MATEO DRIVE",
            "address_2": "SUITE 1",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "94401",
            "telephone_number": "650-347-7014",
            "fax_number": "650-347-5229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 NORTH SAN MATEO DRIVE",
            "address_2": "SUITE 1",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "94401",
            "telephone_number": "650-347-7014",
            "fax_number": "650-347-5229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYATAKE",
        "first_name": "LINDA",
        "middle_name": "KAJLSA",
        "credential": "DDS MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "37567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jonathan Mitchelmore, LCSW
• Tina Mizukami, MFT
• Mobile Health Consumer, Inc.
• Danielle Mock
• Lorraine Mock, L. AC.
• Modesto Radiological Medical Group, Inc

• Oral and Maxillofacial Surgery (Dentist) in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.