Provider Demographics
NPI:1093708133
Name:YAMASHIRO, JEFFREY YASUNORI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:YASUNORI
Last Name:YAMASHIRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3227
Mailing Address - Country:US
Mailing Address - Phone:310-329-1312
Mailing Address - Fax:310-329-1074
Practice Address - Street 1:1605 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3227
Practice Address - Country:US
Practice Address - Phone:310-329-1312
Practice Address - Fax:310-329-1074
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA037046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5707192OtherAETNA PROVIDER NUMBER