Basic Information
| Provider Information | |||||||||
| NPI: | 1265926661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SONODA | ||||||||
| FirstName: | KENTO | ||||||||
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| Credential: | M.D., A.A.H.I.V.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 S. SPRING AVE, SLUCARE ACADEMIC PAVILION | ||||||||
| Address2: | 3RD FLOOR, FAMILY AND COMMUNITY MEDICINE | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149778480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4000 JENNINGS STATION RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631213323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146159700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2018 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MT216745 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD475598 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | 2022007809 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207Q00000X | 2022007809 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.