Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 40407 | CA |
NPI | 1457485294 |
---|---|
Provider Name | Dr. John Michael Yamamoto |
First Address | Los Angeles, CA 90064-4042 |
Second Address | Venice, CA 90291-2842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |