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: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W LA VETA AVE STE 202
ORANGE CA
92866-2607
US

IV. Provider business mailing address

19782 MACARTHUR BLVD STE 300
IRVINE CA
92612-2417
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax:
Mailing address:
  • Phone: 714-545-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: