Provider Demographics
NPI:1386778934
Name:KENNETH S YAMAMOTO MD A MEDICAL CORP
Entity type:Organization
Organization Name:KENNETH S YAMAMOTO MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SUSUMU
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-337-2121
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2225
Mailing Address - Country:US
Mailing Address - Phone:415-337-2121
Mailing Address - Fax:415-337-1247
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2225
Practice Address - Country:US
Practice Address - Phone:415-337-2121
Practice Address - Fax:415-337-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G313400207RC0000X, 207RH0003X
CAG31340207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G313400Medicaid
CAZZZ14116ZMedicare PIN