Provider Demographics
NPI:1033281654
Name:YAMAMOTO, TAKASHI (LAC)
Entity Type:Individual
Prefix:
First Name:TAKASHI
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4342
Mailing Address - Country:US
Mailing Address - Phone:503-480-9697
Mailing Address - Fax:
Practice Address - Street 1:1765 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4342
Practice Address - Country:US
Practice Address - Phone:503-480-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00912171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist