Provider Demographics
NPI:1902486178
Name:YUMOTO, KEIKO
Entity Type:Individual
Prefix:
First Name:KEIKO
Middle Name:
Last Name:YUMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEI
Other - Middle Name:
Other - Last Name:YUMOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:125 2ND ST APT 308
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4565
Mailing Address - Country:US
Mailing Address - Phone:206-898-1918
Mailing Address - Fax:
Practice Address - Street 1:125 2ND ST APT 308
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4565
Practice Address - Country:US
Practice Address - Phone:206-898-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty