MEDICARE: YASUHIRO MATSUMURA

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	39304	CA

General Provider Information

NPI Number	:	1891191912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASUHIRO MATSUMURA

Provider Business Mailing Address
First Line	:	11340 W OLYMPIC BLVD STE 240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1612
Country	:	US
Telephone Number	:	310-575-8828
Fax Number	:

Provider Business Practice Location Address
First Line	:	11340 W OLYMPIC BLVD STE 240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1612
Country	:	US
Telephone Number	:	310-575-8828
Fax Number	:

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

Provider Enumeration Date	:	11/17/2014
Last Update Date	:	11/17/2014

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Directions to “ YASUHIRO MATSUMURA ” Practice Location

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