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General NPI Number Information
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NPI Number | 1104836527
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Entity Type | Individual
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Provider Name | LOREN T YASUNARI O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 450 N ROXBURY DR FL 3
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4232
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Country | US
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Telephone | 310-453-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 10390 WILSHIRE BLVD APT 1008
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City | LOS ANGELES
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State | CA
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Zip | 90024-6420
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Country | US
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Telephone | 310-453-8911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12125T
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License Number State | CA
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