Provider Demographics
NPI:1336239920
Name:YONEMURA, KENNETH STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:STEPHEN
Last Name:YONEMURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:S
Other - Last Name:YONEMURA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6360 S 3000 E STE 210
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6972
Mailing Address - Country:US
Mailing Address - Phone:435-200-1196
Mailing Address - Fax:800-886-1421
Practice Address - Street 1:6360 S 3000 E STE 210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6972
Practice Address - Country:US
Practice Address - Phone:435-200-1196
Practice Address - Fax:800-886-1421
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5755549-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery