Provider Demographics
NPI:1457337362
Name:YAMADA, RONALD RYO (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RYO
Last Name:YAMADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-0230
Mailing Address - Country:US
Mailing Address - Phone:916-989-1887
Mailing Address - Fax:916-989-1887
Practice Address - Street 1:1191 E YOSEMITE AVE
Practice Address - Street 2:STE 203
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5011
Practice Address - Country:US
Practice Address - Phone:916-989-1887
Practice Address - Fax:916-989-1887
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30653207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11135588OtherCAQH
OR105782Medicare ID - Type Unspecified
CAA44503Medicare UPIN