Organization
KENTARO E YAMADA M.D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENTARO E YAMADA M.D. (PRESIDENT)
(619) 299-1100
Entity
Organization
Contact information
Practice address
1040 UNIVERSITY AVE STE B209A, SAN DIEGO, CA 92103-7328
(619) 299-1100
(619) 299-7156
Mailing address
1040 UNIVERSITY AVE STE B209A, SAN DIEGO, CA 92103-7328
(161) 929-9110
(619) 299-7156
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A953870
—
CA
01
—
WA95387A
MEDICARE PPIN
CA
Enumeration date
09/20/2006
Last updated
03/10/2022
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