Healthcare Provider Details

I. General information

NPI: 1609946037
Provider Name (Legal Business Name): EDWARD Y. HENJYOJI, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 ROLLING OAKS DR SUITE 101
THOUSAND OAKS CA
91361-1275
US

IV. Provider business mailing address

351 ROLLING OAKS DR SUITE 101
THOUSAND OAKS CA
91361-1275
US

V. Phone/Fax

Practice location:
  • Phone: 805-449-4194
  • Fax: 805-497-6144
Mailing address:
  • Phone: 805-449-4194
  • Fax: 805-497-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberC32972
License Number StateCA

VIII. Authorized Official

Name: EDWARD Y HENJYOJI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-494-3656