Jerry Kiyoharu Wada, M.D.

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

G22808 Issued in CA

Practice address

1505 Wilson Ter Ste 200
Glendale, CA 91206-4073

Phone

(818) 409-0105

Fax

(818) 409-0151

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Los Angeles Hematology-Oncology Medical Group

  • Specialist
  • Los Angeles, CA
  • NPI 1457409674

  Hematology & Oncology

  NPD
• Los Angeles Hematology-Oncology Medical Group

  • Non-Pharmacy Dispensing Site
  • Glendale, CA
  • NPI 1952516627

  Hematology & Oncology

  NPD

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1487764379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 W COLORADO ST STE 205",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912043640",
            "telephone_number": "323-254-0046",
            "fax_number": "323-488-9782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 WILSON TER STE 200",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064073",
            "telephone_number": "818-409-0105",
            "fax_number": "818-409-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADA",
        "first_name": "JERRY",
        "middle_name": "KIYOHARU",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "G22808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G228080",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICAL LICENSE",
            "identifier": "G22808",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maureen Iser Vukojevich, M.S., CCC-SLP
• Judith Ann Vukov, MD
• Kien Quang Vuu, MD
• Vytal Surgery Center of Glendale
• W. David Mello, M.D., Inc.,a Professional Corporation
• Christina T Wade, MD
• Nancy Lynn Wade, PHD
• Patrick Wade, M.D.
• Alicia Wagner, DPT
• Tahsin Ali Waheb, M.D.

• Hematology & Oncology Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Hematology & Oncology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.