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NPI Code Detail

MEDICARE: KENTARO EMIL YAMADA MD

MEDICARE: KENTARO EMIL YAMADA MD
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
1207W00000XOphthalmology PhysicianA95387CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629047188
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENTARO EMIL YAMADA MD
Provider Business Mailing Address
First Line : 1040 UNIVERSITY AVE STE B209A
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-7328
Country : US
Telephone Number : 619-299-1100
Fax Number : 619-299-7156
Provider Business Practice Location Address
First Line : 4094 FOURTH AVE
Second Line : STE 203
City : SAN DIEGO
State : CA
Zip : 92103-2143
Country : US
Telephone Number : 619-299-1100
Fax Number : 619-299-7156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 03/10/2022

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Directions to “ KENTARO EMIL YAMADA MD” Practice Location

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