Healthcare Provider Details

I. General information

NPI: 1518803824
Provider Name (Legal Business Name): YUKIYOSHI KIMURA SANDOVAL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215
US

IV. Provider business mailing address

AV SANTA FE 462 INT 1507B
MEXICO CITY MEXICO CITY
05348
MX

V. Phone/Fax

Practice location:
  • Phone: 617-667-3524
  • Fax: 617-667-3513
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3020193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: