MEDICARE: DR. LESLIE T YONEMOTO M.D.

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	2085R0001X	Radiation Oncology Physician	A51355	CA
2	2085R0001X	Radiation Oncology Physician	30459	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00756929	OTHER	CA	RR MEDICARE

General Provider Information

NPI Number	:	1336235456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE T YONEMOTO M.D.

Provider Business Mailing Address
First Line	:	2525 NW EXPRESSWAY
Second Line	:	SUITE 404
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7227
Country	:	US
Telephone Number	:	405-607-4520
Fax Number	:	405-607-4525

Provider Business Practice Location Address
First Line	:	5901 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-2015
Country	:	US
Telephone Number	:	405-773-6700
Fax Number	:	405-720-3910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	10/12/2021

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