Provider Demographics
NPI:1861757890
Name:YAMAZAKI, STEVEN KIYOSHI (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KIYOSHI
Last Name:YAMAZAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KIYOSHI
Other - Middle Name:
Other - Last Name:YAMAZAKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17005 HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7657
Mailing Address - Country:US
Mailing Address - Phone:229-312-1000
Mailing Address - Fax:
Practice Address - Street 1:831 S PERRY ST
Practice Address - Street 2:#200
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1919
Practice Address - Country:US
Practice Address - Phone:303-218-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66919207QS0010X
CODR.0056881207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59317515Medicaid
CODR.0056881OtherCOLORADO STATE LICENSE
CO59317515Medicaid