MEDICARE: DR. JEFFREY YASUNORI YAMASHIRO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	037046	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5707192	OTHER	CA	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1093708133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY YASUNORI YAMASHIRO DDS

Provider Business Mailing Address
First Line	:	1605 W REDONDO BEACH BLVD
Second Line	:	SUITE #203
City	:	GARDENA
State	:	CA
Zip	:	90247-3227
Country	:	US
Telephone Number	:	310-329-1312
Fax Number	:	310-329-1074

Provider Business Practice Location Address
First Line	:	1605 W REDONDO BEACH BLVD
Second Line	:	SUITE #203
City	:	GARDENA
State	:	CA
Zip	:	90247-3227
Country	:	US
Telephone Number	:	310-329-1312
Fax Number	:	310-329-1074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/08/2007

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