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NPI Code Detail

MEDICARE: MR. KEN KEIJI YABUKI MFT

MEDICARE: MR. KEN KEIJI YABUKI MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 12443CA

General Provider Information

NPI Number : 1962531061
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEN KEIJI YABUKI MFT
Provider Business Mailing Address
First Line : 11971 PEACH TREE RD
Second Line :
City : YUCAIPA
State : CA
Zip : 92399-2759
Country : US
Telephone Number : 909-446-7178
Fax Number :
Provider Business Practice Location Address
First Line : 340 N. MADISON AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3504
Country : US
Telephone Number : 323-644-2026
Fax Number : 323-644-2039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2007

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