Provider Demographics
NPI:1710905435
Name:YAMADA, KELVIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:A
Last Name:YAMADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8111
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-6120
Mailing Address - Fax:314-454-2523
Practice Address - Street 1:1600 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1320
Practice Address - Country:US
Practice Address - Phone:314-362-4342
Practice Address - Fax:314-747-3813
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR2G002084N0402X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202815528Medicaid
MO130010600Medicare PIN
MO035010101Medicaid
MO035010101Medicare PIN