Kenneth Edward Yaw, PA-C
Physician Assistant in Summerset, SD. Individual provider (NPI-1).
NPI number1982166377
StatusActive
Last updated in NPPESJun 29, 2022
Details
- NPI
- 1982166377
- Entity type
- Individual (NPI-1)
- Name
- Kenneth Edward Yaw
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 3, 2019
- Certification date
- Jun 29, 2022
- Last updated
- Jun 29, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 1363 | SD | Yes |
| 363A00000X | Physician Assistant | 7377 | AZ |
Practice location
8064 Steamboat CtSummerset, SD 57769-6213
Phone 209-601-0780
Mailing address
8064 Steamboat CtSummerset, SD 57769-6213
Phone 209-601-0780
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