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General NPI Number Information
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NPI Number | 1700206273
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Entity Type | Individual
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Provider Name | JARROD NOBUYOSHI YAMANAKA MD
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Gender | Male
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 10961 CLUB WEST PKWY NE STE 200
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City | BLAINE
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State | MN
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Zip | 55449-5866
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Country | US
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Telephone | 763-528-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 10961 CLUB WEST PKWY
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City | BLAINE
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State | MN
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Zip | 55449-5866
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Country | US
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Telephone | 763-528-2992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 60010
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License Number State | MN
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