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General NPI Number Information
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NPI Number | 1568677243
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Entity Type | Organization
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Legal Business Name | KENNETH Y. YAMANAKA D.D.S.,INC.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1941 HUNTINGTON DR STE D
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5601
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Country | US
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Telephone | 626-799-4187
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Fax | 626-799-4540
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Provider Business Mailing Address
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Address Line | 1941 HUNTINGTON DR STE D
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5601
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Country | US
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Telephone | 626-799-4187
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Fax | 626-799-4540
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARILEE PETERSON CHAPPELL
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Credential | RDA
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Telephone | 626-799-4187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21419
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License Number State | CA
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