=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689723520
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELI PERFECTO YAGASAKI D.D.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23601 CRENSHAW BLVD
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-257-8043
-----------------------------------------------------
Fax | 310-257-1155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23601 CRENSHAW BLVD
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-257-8043
-----------------------------------------------------
Fax | 310-257-1155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 48203
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------