Healthcare Provider Details

I. General information

NPI: 1669529244
Provider Name (Legal Business Name): THOMAS Y. IWASHITA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11562 KNOTT ST STE 17
GARDEN GROVE CA
92841-1823
US

IV. Provider business mailing address

11562 KNOTT ST STE 17
GARDEN GROVE CA
92841-1823
US

V. Phone/Fax

Practice location:
  • Phone: 714-209-7602
  • Fax: 714-209-7465
Mailing address:
  • Phone: 714-209-7602
  • Fax: 714-209-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: