MEDICARE: CARL Y. YAMAGUCHI DDS APC

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	020298	CA

General Provider Information

NPI Number	:	1790790194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL Y. YAMAGUCHI DDS APC

Provider Business Mailing Address
First Line	:	1276 E WASHINGTON AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3036
Country	:	US
Telephone Number	:	619-440-9211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 E WASHINGTON AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3036
Country	:	US
Telephone Number	:	619-440-9211
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARL YUKIO YAMAGUCHI
Credential	:	DDS
Telephone Number	:	619-440-9211

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	12/21/2007

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