Provider Demographics
NPI:1548951528
Name:YORK, MICK TAKESHI KIMURA (PA-C)
Entity type:Individual
Prefix:
First Name:MICK
Middle Name:TAKESHI KIMURA
Last Name:YORK
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:115 NEPTUNE PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3949
Mailing Address - Country:US
Mailing Address - Phone:510-604-8636
Mailing Address - Fax:
Practice Address - Street 1:8 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13699-1401
Practice Address - Country:US
Practice Address - Phone:315-268-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-30
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant