Healthcare Provider Details

I. General information

NPI: 1003075656
Provider Name (Legal Business Name): BRYCE K. YAMAUCHI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2008
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 155TH ST SUITE 210
GARDENA CA
90247-4048
US

IV. Provider business mailing address

PO BOX 66596
SEATTLE WA
98166-0596
US

V. Phone/Fax

Practice location:
  • Phone: 310-767-1538
  • Fax:
Mailing address:
  • Phone: 626-960-5021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3477
License Number StateCA

VIII. Authorized Official

Name: DR. BRYCE KIYOSHI YAMAUCHI
Title or Position: OWNER
Credential: D.P.M.
Phone: 310-767-1538