MEDICARE: MARIE K. YAMAMOTOYA 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	207Q00000X	Family Medicine Physician	A61112	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	:	1487732111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE K. YAMAMOTOYA MD

Provider Business Mailing Address
First Line	:	2855 E MANOA RD STE 105
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-1854
Country	:	US
Telephone Number	:	916-802-7601
Fax Number	:	808-515-4184

Provider Business Practice Location Address
First Line	:	470 CHADBOURNE RD STE A
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-9620
Country	:	US
Telephone Number	:	707-419-8989
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	01/29/2025

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