Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DD4531 | NM |
Y | 122300000X | Dentist | DEN.00203512 | CO |
NPI | 1003266164 |
---|---|
Provider Name | Dr. Yasufumi Yamazaki |
First Address | Colorado Springs, CO 80909-8009 |
Second Address | Colorado Springs, CO 80916-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 13/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003266164 | (05) | CO |
67501851 | (05) | NM |