MEDICARE: DR. KENNETH SUSUMU YAMAMOTO MD

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	207R00000X	Internal Medicine Physician	G31340	CA
2	207RH0003X	Hematology & Oncology Physician	G313400	CA
3	207RX0202X	Medical Oncology Physician	G31340	CA
4	207RX0202X	Medical Oncology Physician	G313400	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467545368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH SUSUMU YAMAMOTO MD

Provider Business Mailing Address
First Line	:	1800 SULLIVAN AVE
Second Line	:	SUITE 603
City	:	DALY CITY
State	:	CA
Zip	:	94015-2225
Country	:	US
Telephone Number	:	415-337-2121
Fax Number	:	415-337-1247

Provider Business Practice Location Address
First Line	:	1800 SULLIVAN AVE
Second Line	:	SUITE 603
City	:	DALY CITY
State	:	CA
Zip	:	94015-2225
Country	:	US
Telephone Number	:	415-337-2121
Fax Number	:	415-337-1247

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/21/2022

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Directions to “ DR. KENNETH SUSUMU YAMAMOTO MD” Practice Location

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