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1073550976 NPI number — HERBERT KEIJI WAKAMATSU OD

NPI Number: 1073550976
Health Care Provider/Practitioner: HERBERT KEIJI WAKAMATSU OD

Information about “1073550976” NPI (HERBERT KEIJI WAKAMATSU OD) exists in 1073550976 in HTML format HTML  |  1073550976 in plain Text format TXT  |  1073550976 in PDF (Portable Document Format) PDF  |  1073550976 in an XML format XML  formats.

NPI Number : 1073550976 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073550976",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WAKAMATSU",
    "FirstName": "HERBERT",
    "MiddleName": "KEIJI",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16302 HEARTWOOD CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LA MIRADA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90638-6516",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "562-279-5406",
    "MailingAddressFaxNumber": "213-384-2002",
    "FirstLinePracticeLocationAddress": "3525 W 8TH ST",
    "SecondLinePracticeLocationAddress": "#228B",
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90005-2993",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "213-380-2831",
    "PracticeLocationAddressFaxNumber": "213-384-2002",
    "EnumerationDate": "05/31/2006",
    "LastUpdateDate": "12/01/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "5224T",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "OPT 5224T",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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