Healthcare Provider Details

I. General information

NPI: 1104389915
Provider Name (Legal Business Name): KENJI YUKIO YOSHINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

3500 GASTON AVE
DALLAS TX
75246-2088
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-0111
  • Fax:
Mailing address:
  • Phone: 214-820-9543
  • Fax: 214-820-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR77482
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: