Healthcare Provider Details

I. General information

NPI: 1831319920
Provider Name (Legal Business Name): JEROME K YAMADA DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 112TH AVE NE SUITE B
BELLEVUE WA
98004-5807
US

IV. Provider business mailing address

121 112TH AVE NE SUITE B
BELLEVUE WA
98004-5807
US

V. Phone/Fax

Practice location:
  • Phone: 425-974-7014
  • Fax: 425-974-7017
Mailing address:
  • Phone: 425-974-7014
  • Fax: 425-974-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9011
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: