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Jerry Kiyoharu Wada, MD
Hematology & Oncology Physician in Glendale, California
NPI 1487764379

Jerry Kiyoharu Wada is a Hematology & Oncology Physician based in Glendale, CA and is specialized in Hematology & Oncology. Jerry Kiyoharu Wada practices in Glendale, CA and has the professional credentials of MD. The NPI Number for Jerry Kiyoharu Wada is 1487764379 and holds a License No. G22808 (California).

The current practice location address for Jerry Kiyoharu Wada is 1505 Wilson Ter Ste 200, Glendale, CA and can be reached out via phone at 818-409-0105 and via fax at 818-409-0151. You can also correspond with Jerry Kiyoharu Wada through the mailing address at 541 W COLORADO ST STE 205, GLENDALE, CA - 91204-3640 (mailing address contact number: 323-254-0046).

Location: 1505 Wilson Ter Ste 200, Glendale, CA, 91204-3640
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1487764379
Provider Name
Jerry Kiyoharu Wada
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1505 Wilson Ter Ste 200, Glendale, CA, 91204-3640
Phone Number
818-409-0105
Fax Number
818-409-0151
Provider Enumeration Date
08/30/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00G228080 05 CA
G22808 01 CA CA MEDICAL LICENSE
institution
Provider Business Practice Location Address Details
Address
1505 Wilson Ter Ste 200
City
Glendale
State
California
Zip
91206-4073
Phone Number
818-409-0105
Fax Number
818-409-0151
person
Provider Business Mailing Address Details
Address
541 W Colorado St Ste 205
City
Glendale
State
California
Zip
91204-3640
Phone Number
323-254-0046
Fax Number
323-488-9782
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Internal Medicine
Speciality
Hematology & Oncology
Taxonomy
207RH0003X
License No.
G22808 (California)
Definition
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.
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