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General NPI Number Information
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NPI Number | 1922569938
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Entity Type | Individual
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Provider Name | GREGORY YAMAGUCHI OD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2019
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 250 N ROBERTSON BLVD STE 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1767
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Country | US
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Telephone | 310-385-3450
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 EAST BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-4609
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Country | US
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Telephone | 310-749-1217
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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 | OPT-002373
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT34640
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License Number State | CA
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