Provider Demographics
NPI:1760456040
Name:YAMADA, ALAN H (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:H
Last Name:YAMADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 W DUARTE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7603
Mailing Address - Country:US
Mailing Address - Phone:626-446-8595
Mailing Address - Fax:626-446-1031
Practice Address - Street 1:624 W DUARTE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7603
Practice Address - Country:US
Practice Address - Phone:626-446-8595
Practice Address - Fax:626-446-1031
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG65367208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G653670Medicaid
CA1139410001Medicare NSC
CA00G653670Medicaid
CA340011707Medicare PIN
CAWG65367DMedicare PIN