Provider Information for 1760625644
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JADE YUKO YAMADA
Sex: Female
NPI: 1760625644
Last Updated: 2021-10-26
Certification Date: 2021-10-22
Certification Date: 2021-10-22
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1760625644 | ||||||||
| Enumeration Date | 2009-04-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 231 E 3RD ST STE G106 LOS ANGELES, CA 90013-1493 United States Phone: 714-292-1392 | Fax: | ||||||||
| Primary Practice Address | 4325 W SUNSET BLVD STE 206 LOS ANGELES, CA 90029-2180 United States Phone: 714-292-1392 | Fax: | ||||||||
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