Healthcare Provider Details

I. General information

NPI: 1740654607
Provider Name (Legal Business Name): JONATHAN T YAMAGUCHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JON T YAMAGUCHI

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY DEPT 148
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

710 LAWRENCE EXPY DEPT 148
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 480-789-9960
  • Fax:
Mailing address:
  • Phone: 480-789-9960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA208618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: