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Next Update: Thursday, December 19, 2024 12:00 PM CST
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KISHIMOTO, WAYNE MINORU
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This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
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| Practice Address: |
609 DEEP VALLEY DRIVE
SUITE 200
ROLLING HILLS CA 90274
Address last updated on 7/2/2019 |
| Phone #: |
(310) 706-4440 |
| Fax #: |
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| County: |
NOT OKLAHOMA |
| License: |
27366 |
| Dated: |
9/22/2009 |
| Expires: |
1/30/2021 |
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Temp.
Lic.
Issued:
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9/4/2009 |
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Temp.
Lic.
Expires:
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11/20/2009 |
| License Type: |
Medical Doctor |
| Specialty: |
Radiology
Diagnostic Radiology |
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| Status: |
Inactive |
| Status Class: |
Expired License |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Keck Sch of Med of the USC, LOS ANGELES CA 90089 |
| Graduated: |
5 /
2001 |
| CME Year: |
2021 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
AMERICAN BOARD OF RADIOLOGY (Diagnostic Radiology specific) |
| New Patients: |
Contact licensee |
| Medicaid: |
Contact licensee |
| Medicare: |
Contact licensee |
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| HMO/PPO: |
None listed |
| Hospital Privileges: |
OU Health Medical Center
Oklahoma City, OK
OU Medical Center - Edmond
Edmond, OK
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