Healthcare Provider Details

I. General information

NPI: 1750508750
Provider Name (Legal Business Name): WESLEY PAUL YEMOTO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 CHERRY AVE STE F
SAN JOSE CA
95118-3716
US

IV. Provider business mailing address

4860 CHERRY AVE STE F
SAN JOSE CA
95118-3716
US

V. Phone/Fax

Practice location:
  • Phone: 408-266-9957
  • Fax: 408-266-1407
Mailing address:
  • Phone: 408-266-9957
  • Fax: 408-266-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: