Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036-100832 | IL |
NPI | 1275561409 |
---|---|
Provider Name | Seiko Diane Yamada |
First Address | Chicago, IL 60637-1447 |
Second Address | Chicago, IL 60637-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036100832 | STATE LICENSE (01) | IL |
G36621 | (02) |