Basic Information
| Provider Information | |||||||||
| NPI: | 1477503845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UMEMOTO | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | SEIJI | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 POWELL STREET STE 920 | ||||||||
| Address2: | |||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103502777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10401 WEST THUNDERBIRD BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239777211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35259 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A86503 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 122377 | 05 | AZ | MEDICAID |