Healthcare Provider Details

I. General information

NPI: 1053667220
Provider Name (Legal Business Name): YUICHI ISHIDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR BLDG 31
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

1 HOAG DR BLDG 31
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8258
  • Fax: 949-764-1493
Mailing address:
  • Phone: 949-764-8258
  • Fax: 949-764-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10044691
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-46280
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD-46280
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA138253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: