Healthcare Provider Details

I. General information

NPI: 1336724004
Provider Name (Legal Business Name): YAMA MED, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SULLIVAN AVE STE 300
DALY CITY CA
94015-2204
US

IV. Provider business mailing address

1850 SULLIVAN AVE STE 300
DALY CITY CA
94015-2204
US

V. Phone/Fax

Practice location:
  • Phone: 650-992-4000
  • Fax:
Mailing address:
  • Phone: 650-991-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHARINE ANN KISHIYAMA
Title or Position: MD
Credential: MD
Phone: 703-402-0447