Provider Demographics
NPI:1700231529
Name:YAMAMOTO, JUN (MD, PH D)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-0533
Mailing Address - Country:US
Mailing Address - Phone:907-744-0620
Mailing Address - Fax:907-744-0620
Practice Address - Street 1:217 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-9270
Practice Address - Country:US
Practice Address - Phone:907-744-0620
Practice Address - Fax:907-744-0620
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK31091856390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program