Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0401415207 | VA |
N | 1223E0200X | Endodontist | LL802 | MD |
NPI | 1033664941 |
---|---|
Provider Name | Dr. Maimi Yamaguchi |
First Address | Vienna, VA 22182-3872 |
Second Address | Vienna, VA 22182-3872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2016 |
Last Update Date | 03/08/2017 |