Healthcare Provider Details

I. General information

NPI: 1952994931
Provider Name (Legal Business Name): JUSTIN YAMAGUCHI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E YALE LOOP STE. 201
IRVINE CA
92604
US

IV. Provider business mailing address

3230 E. IMPERIAL HWY SUITE 100
BREA CA
92821-6735
US

V. Phone/Fax

Practice location:
  • Phone: 949-265-2442
  • Fax: 714-256-0770
Mailing address:
  • Phone: 714-988-8110
  • Fax: 714-988-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number299866
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: