Healthcare Provider Details

I. General information

NPI: 1982191755
Provider Name (Legal Business Name): MIYA YOSHIDA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 10/22/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 470
ORANGE CA
92868-4305
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 470
ORANGE CA
92868-4305
US

V. Phone/Fax

Practice location:
  • Phone: 714-706-9308
  • Fax: 714-706-9309
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A19120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: