Provider Demographics
NPI:1467441337
Name:YAMADA, KAZUE (MD)
Entity Type:Individual
Prefix:
First Name:KAZUE
Middle Name:
Last Name:YAMADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2432
Mailing Address - Country:US
Mailing Address - Phone:602-864-0877
Mailing Address - Fax:602-864-9392
Practice Address - Street 1:5720 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2432
Practice Address - Country:US
Practice Address - Phone:602-864-0877
Practice Address - Fax:602-864-9392
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics