1881782209 NPI number — MRS. SUSAN KAORU YAMAMOTO RN

Table of content: MRS. SUSAN KAORU YAMAMOTO RN (NPI 1881782209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881782209 NPI number — MRS. SUSAN KAORU YAMAMOTO RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAMAMOTO
Provider First Name:
SUSAN
Provider Middle Name:
KAORU
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BABA
Provider Other First Name:
SUSAN
Provider Other Middle Name:
KAORU
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881782209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 N ELECTRIC AVE
Provider Second Line Business Mailing Address:
1
Provider Business Mailing Address City Name:
ALHAMBRA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-281-1549
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 E WINSTON STREET
Provider Second Line Business Practice Location Address:
LA MISSION COMMUNITY CLINIC
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-893-1960
Provider Business Practice Location Address Fax Number:
213-893-1962
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  276172 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CMM70948F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: EAP70948F . This is a "EAPC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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