Individual
CHASE KIYOSHI YAMAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CBRS
Contact information
Practice address
6795 N MINERAL DR, COEUR D ALENE, ID 83815-8700
(208) 769-4222
(844) 803-7399
Mailing address
P.O.B.1387, HAYDEN, ID 83835
(208) 415-0299
(208) 625-2070
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AD005757R
DRIVERS LICENSE
ID
Enumeration date
07/16/2020
Last updated
10/05/2020
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