Healthcare Provider Details

I. General information

NPI: 1134031214
Provider Name (Legal Business Name): MASAHIKO MARVIN YASUDA CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 N FAIRFAX AVE
WEST HOLLYWOOD CA
90046-6103
US

IV. Provider business mailing address

1042 N FAIRFAX AVE
WEST HOLLYWOOD CA
90046-6103
US

V. Phone/Fax

Practice location:
  • Phone: 310-720-4474
  • Fax:
Mailing address:
  • Phone: 310-720-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number103285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: