Provider Demographics
NPI:1336724004
Name:YAMA MED, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:YAMA MED, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KISHIYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-402-0447
Mailing Address - Street 1:1850 SULLIVAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2204
Mailing Address - Country:US
Mailing Address - Phone:650-991-1122
Mailing Address - Fax:
Practice Address - Street 1:1850 SULLIVAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2204
Practice Address - Country:US
Practice Address - Phone:650-992-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty