Provider Demographics
NPI:1114071073
Name:YOSHINAGA, PATRICK D (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:D
Last Name:YOSHINAGA
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 1:823 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4721
Mailing Address - Country:US
Mailing Address - Phone:626-570-8800
Mailing Address - Fax:626-570-8892
Practice Address - Street 1:823 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4721
Practice Address - Country:US
Practice Address - Phone:626-570-8800
Practice Address - Fax:626-570-8892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7729TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12856OtherMEDICAL EYE SERVICES EYEC
CA211165OtherEYEMED
CAT87911Medicare UPIN
CAP00332920Medicare ID - Type UnspecifiedRAILROAD MEDICARE
CAOP7729Medicare ID - Type UnspecifiedMEDICARE