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General NPI Number Information
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NPI Number | 1568659340
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Entity Type | Individual
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Provider Name | SHAWN TAKASHI YAMAMOTO O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 4275 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90807-2801
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Country | US
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Telephone | 562-595-5662
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Fax | 562-988-2082
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Provider Business Mailing Address
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Address Line | 2551 PEARBLOSSOM ST
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City | FULLERTON
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State | CA
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Zip | 92835-4407
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Country | US
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Telephone | 714-869-3239
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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 | 13421
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License Number State | CA
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