Healthcare Provider Details

I. General information

NPI: 1639172174
Provider Name (Legal Business Name): JOSHUA SHIGERU YAMAMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW STE 202
WASHINGTON DC
20016-3627
US

IV. Provider business mailing address

3301 NEW MEXICO AVE NW STE 202
WASHINGTON DC
20016-3627
US

V. Phone/Fax

Practice location:
  • Phone: 202-243-0271
  • Fax: 202-537-0075
Mailing address:
  • Phone: 202-243-0271
  • Fax: 202-537-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD035778
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0051320
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: