Provider Demographics
NPI:1487732111
Name:YAMAMOTOYA, MARIE K (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:K
Last Name:YAMAMOTOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 E MANOA RD STE 105
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1854
Mailing Address - Country:US
Mailing Address - Phone:916-802-7601
Mailing Address - Fax:808-515-4184
Practice Address - Street 1:470 CHADBOURNE RD STE A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9620
Practice Address - Country:US
Practice Address - Phone:707-419-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A611120Medicaid
G73994Medicare UPIN
00A611120Medicare ID - Type Unspecified