Healthcare Provider Details

I. General information

NPI: 1104840602
Provider Name (Legal Business Name): TAKASHI STEVE YOSHIMURA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8246 SUNLAND BLVD
SUN VALLEY CA
91352-3301
US

IV. Provider business mailing address

10375 TOPEKA DR
NORTHRIDGE CA
91326-3334
US

V. Phone/Fax

Practice location:
  • Phone: 818-767-0177
  • Fax:
Mailing address:
  • Phone: 818-360-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: