MEDICARE: MR. MARK STEVEN YAMAKA C.P.

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	225000000X	Orthotic Fitter	CP001339	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376736942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK STEVEN YAMAKA C.P.

Provider Business Mailing Address
First Line	:	5940 E WASHINGTON BLVD
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-2413
Country	:	US
Telephone Number	:	323-721-6706
Fax Number	:	323-721-6746

Provider Business Practice Location Address
First Line	:	5940 E WASHINGTON BLVD
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-2413
Country	:	US
Telephone Number	:	323-721-6706
Fax Number	:	323-721-6746

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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