MEDICARE: DR. KELVIN A YAMADA 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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	R2G00	MO
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	R2G00	MO

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	:	1710905435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELVIN A YAMADA MD

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:	C B 8111
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	314-454-6120
Fax Number	:	314-454-2523

Provider Business Practice Location Address
First Line	:	1600 S BRENTWOOD BLVD
Second Line	:	SUITE 600
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1320
Country	:	US
Telephone Number	:	314-362-4342
Fax Number	:	314-747-3813

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/14/2016

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