Provider Demographics
NPI:1699782367
Name:YAM, JOHN I
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:I
Last Name:YAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 152ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5520
Mailing Address - Country:US
Mailing Address - Phone:425-746-2400
Mailing Address - Fax:425-746-2659
Practice Address - Street 1:2103 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5520
Practice Address - Country:US
Practice Address - Phone:425-746-2400
Practice Address - Fax:425-746-2659
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD13395207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A05956Medicare UPIN
WAAB34696Medicare ID - Type Unspecified