Provider Demographics
NPI:1013004852
Name:YAMANAKA, MARK K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:YAMANAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 WARING RD STE 2
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4454
Mailing Address - Country:US
Mailing Address - Phone:760-941-0221
Mailing Address - Fax:760-941-0905
Practice Address - Street 1:3907 WARING RD STE 2
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4454
Practice Address - Country:US
Practice Address - Phone:760-941-0221
Practice Address - Fax:760-941-0905
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48542207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE89636Medicare UPIN
CAG48542Medicare PIN