Provider Demographics
NPI:1073763785
Name:YAMAMOTO, KAYOKO
Entity Type:Individual
Prefix:
First Name:KAYOKO
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 7TH AVE APT 29
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2734
Mailing Address - Country:US
Mailing Address - Phone:831-476-8211
Mailing Address - Fax:
Practice Address - Street 1:526 SOQUEL AVE STE D
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2321
Practice Address - Country:US
Practice Address - Phone:831-818-2440
Practice Address - Fax:831-818-2440
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist