Healthcare Provider Details

I. General information

NPI: 1790603207
Provider Name (Legal Business Name): HIROMI YAGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28901 S WESTERN AVE STE 135
RANCHO PALOS VERDES CA
90275-0824
US

IV. Provider business mailing address

28901 S WESTERN AVE STE 135
RANCHO PALOS VERDES CA
90275-0824
US

V. Phone/Fax

Practice location:
  • Phone: 310-750-2470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number113286
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: