Provider Demographics
NPI:1073127924
Name:SAMBOMMATSU, YUZURU
Entity Type:Individual
Prefix:
First Name:YUZURU
Middle Name:
Last Name:SAMBOMMATSU
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 1:1200 E. BROAD STREET P.O. BOX 980057
Mailing Address - Street 2:15TH FLOOR. NORTH WING
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0057
Mailing Address - Country:US
Mailing Address - Phone:804-828-9298
Mailing Address - Fax:804-828-2462
Practice Address - Street 1:1200 E. MARSHALL STREET
Practice Address - Street 2:VCU HEALTH SYSTEM GATEWAY 7TH FLOOR
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-828-4104
Practice Address - Fax:804-828-0854
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275438204F00000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery