MEDICARE: YASUKO KIDOKORO MD A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A032727	CA

General Provider Information

NPI Number	:	1144595000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YASUKO KIDOKORO MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	4282 GENESEE AVE
Second Line	:	SUITE 202
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4989
Country	:	US
Telephone Number	:	858-277-9669
Fax Number	:	858-277-9901

Provider Business Practice Location Address
First Line	:	4282 GENESEE AVE
Second Line	:	SUITE 202
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4989
Country	:	US
Telephone Number	:	858-277-9669
Fax Number	:	858-277-9901

Authorized Official
Title or Position	:	MD
Name	:	YASUKO KIDOKORO
Credential	:	MD
Telephone Number	:	858-277-9669

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	04/11/2019

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