MEDICARE: YUSUKE HAMADA D.D.S, M.S.D,

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	1223P0300X	Periodontics	108114	CA
2	1223P0300X	Periodontics	12012407A	IN

General Provider Information

NPI Number	:	1609242411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUSUKE HAMADA D.D.S, M.S.D,

Provider Business Mailing Address
First Line	:	10833 LE CONTE AVE # 63-022A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1668
Country	:	US
Telephone Number	:	317-874-7860
Fax Number	:

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-5211
Country	:	US
Telephone Number	:	310-825-5543
Fax Number	:

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

Provider Enumeration Date	:	08/16/2015
Last Update Date	:	09/23/2022

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