Healthcare Provider Details

I. General information

NPI: 1083981997
Provider Name (Legal Business Name): KYOKO YAMASHITA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2011
Last Update Date: 11/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18515 DEVONSHIRE ST
NORTHRIDGE CA
91324-1308
US

IV. Provider business mailing address

18400 MALDEN ST APT 24
NORTHRIDGE CA
91325-3635
US

V. Phone/Fax

Practice location:
  • Phone: 818-363-1067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65973
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: