Healthcare Provider Details

I. General information

NPI: 1912703307
Provider Name (Legal Business Name): HIROSHI YAMAMOTO VALENZUELA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 N CHESTNUT AVE STE 104
FRESNO CA
93720-0349
US

IV. Provider business mailing address

440 LYON ST
REEDLEY CA
93654-8891
US

V. Phone/Fax

Practice location:
  • Phone: 787-340-3015
  • Fax: 559-475-0389
Mailing address:
  • Phone: 787-340-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: