MEDICARE: TAKAYO SHIBATA YANG RD

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1588511844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKAYO SHIBATA YANG RD

Provider Business Mailing Address
First Line	:	12138 FERNCREST PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12138 FERNCREST PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4349
Country	:	US
Telephone Number	:	858-829-6202
Fax Number	:

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

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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Directions to “ TAKAYO SHIBATA YANG RD” Practice Location

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