Healthcare Provider Details

I. General information

NPI: 1730383522
Provider Name (Legal Business Name): KEITH NORI YABUMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S 1ST ST
ALHAMBRA CA
91801-3700
US

IV. Provider business mailing address

220 S 1ST ST
ALHAMBRA CA
91801-3700
US

V. Phone/Fax

Practice location:
  • Phone: 626-281-8663
  • Fax: 626-281-6318
Mailing address:
  • Phone: 626-281-8663
  • Fax: 626-281-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA84381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: