MEDICARE: MICHELE YAMADA,DDS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	37613	CA

General Provider Information

NPI Number	:	1083888499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELE YAMADA,DDS, INC

Provider Business Mailing Address
First Line	:	1802 CABLE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3103
Country	:	US
Telephone Number	:	619-223-3423
Fax Number	:	619-223-2950

Provider Business Practice Location Address
First Line	:	1802 CABLE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3103
Country	:	US
Telephone Number	:	619-223-3423
Fax Number	:	619-223-2950

Authorized Official
Title or Position	:	CEO
Name	:	DR. MICHELE YAMADA
Credential	:	DDS
Telephone Number	:	619-223-3423

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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