Kayne K Kishiyama, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

M-6638 Issued in ID

Practice address

1498 Midway Ave
Suite 2
Ammon, ID 83406-4587

Phone

(208) 552-0920

Fax

(208) 529-2564

NPI assigned

Jun 14, 2006

Last updated

Apr 29, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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

• Kayne Kishiyama MD PA

  • Psychiatry Physician
  • Idaho Falls, ID
  • NPI 1457518110
  Authorized official Same address or phone
• Bore LLC

  • Family Medicine Physician
  • Ammon, ID
  • NPI 1447880570
  NPD (past)
• Magic Valley Regional Medical Center

  • Psychiatric Hospital
  • Twin Falls, ID
  • NPI 1447208947
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367193600000",
    "number": "1568405405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1498 MIDWAY AVE",
            "address_2": "SUITE 2",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064587",
            "telephone_number": "208-552-0920",
            "fax_number": "208-529-2564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1498 MIDWAY AVE",
            "address_2": "SUITE 2",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064587",
            "telephone_number": "208-552-0920",
            "fax_number": "208-529-2564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISHIYAMA",
        "first_name": "KAYNE",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2013-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M-6638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804042400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kerry Anne Kearl, SLP
• Cara Kent
• Cheryl Jean Kidd, BS
• Emily King, BA
• Ruth Ellen King, R.N.
• Johnathan Koelsch, LMSW
• Megan Krebs
• Venetta Kreps
• Shawn Lapray, LCPC
• Cheri Jo Larsen

• Psychiatry Physician in Ammon, ID
• Providers in Ammon, ID by specialty
• Psychiatry Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2013; 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.