Healthcare Provider Details

I. General information

NPI: 1578516662
Provider Name (Legal Business Name): DEAN TAKAO YAMAGUCHI M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD RESEARCH SERVICE 151
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD RESEARCH SERVICE 151
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-4437
  • Fax: 310-268-4856
Mailing address:
  • Phone: 310-268-4437
  • Fax: 310-268-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC40276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: