Healthcare Provider Details

I. General information

NPI: 1063665180
Provider Name (Legal Business Name): YUKO CHRISTINE NAKAMURA D.M.D., M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 MORAGA RD SUITE 7
LAFAYETTE CA
94549-5094
US

IV. Provider business mailing address

895 MORAGA RD SUITE 7
LAFAYETTE CA
94549-5094
US

V. Phone/Fax

Practice location:
  • Phone: 925-283-1212
  • Fax: 925-283-1217
Mailing address:
  • Phone: 925-283-1212
  • Fax: 925-283-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOMS 90
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberA110357
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number055245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: