Provider Demographics
NPI:1104836527
Name:YASUNARI, LOREN T (OD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:T
Last Name:YASUNARI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10390 WILSHIRE BLVD APT 1008
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6420
Mailing Address - Country:US
Mailing Address - Phone:310-453-8911
Mailing Address - Fax:
Practice Address - Street 1:450 N ROXBURY DR FL 3
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4232
Practice Address - Country:US
Practice Address - Phone:310-453-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12125T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12125TOtherLICENSE
CAMY0717201OtherDEA REGISTRATION
CA12125TOtherLICENSE
CAMY0717201OtherDEA REGISTRATION