Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A032727 | CA |
NPI | 1124130901 |
---|---|
Provider Name | Dr. Yasuko Kidokoro |
First Address | San Diego, CA 92117-6952 |
Second Address | San Diego, CA 92117-6952 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 21/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A26909 | (02) |