Wayne Kodama DDS

Primary specialty

DentistTaxonomy code 122300000X

License

38861 Issued in CA

Legal business name

WAYNE KODAMA DDS

Practice address

1275 W Shaw Ave Ste 101
Fresno, CA 93711-3710

Phone

(559) 229-3201

NPI assigned

Jun 9, 2015

Organization subpart

No

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

Authorized official

Name

Susan Kodama

Title

Manager

Phone

(559) 229-3201

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1861873465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 W SHAW AVE STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113710",
            "telephone_number": "559-229-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 W SHAW AVE STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113710",
            "telephone_number": "559-229-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE KODAMA DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-09",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "KODAMA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "559-229-3201"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "38861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Watson, MD
• Joanna Burnett Watterson, MD
• Brett Madison Watts, MFT
• Mary E Watts, LCSW
• Trevor M Watts, DPT, OCS, CSCS
• Christin Fay Weatherby, MFT
• Jenna Weatherson, NP
• Kara Weaver-Mills, AMFT
• Ann-English Dillon Weaver, OT
• Irene Weaver

• Dentist in Fresno, CA
• Providers in Fresno, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; 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.