Healthcare Provider Details

I. General information

NPI: 1114813029
Provider Name (Legal Business Name): PHILLIP YUKIO OKA JR. MSN, RN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 07/18/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GOLDEN SHORE, SUITE 350
LONG BEACH CA
90802
US

IV. Provider business mailing address

16426 CANBERRA CT
HACIENDA HEIGHTS CA
91745-5538
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-8995
  • Fax:
Mailing address:
  • Phone: 626-506-9548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95048008
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: