Provider Demographics
NPI:1114901329
Name:NAKATANI, YASUHIRO (MD)
Entity Type:Individual
Prefix:
First Name:YASUHIRO
Middle Name:
Last Name:NAKATANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DRIVE SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:MSC 10-5550
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-5666
Practice Address - Fax:505-272-4435
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36376207RI0200X
NM95-309207RI0200X
CAA054401207RI0200X
AZ22376207RI0200X
IN01057741A207RI0200X
KY38165207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ180753Medicaid
AZ101998Medicare ID - Type Unspecified
AZF76787Medicare UPIN