Provider Demographics
NPI:1275528911
Name:YOSHINO, KENJI (DPT, AT, C)
Entity Type:Individual
Prefix:MR
First Name:KENJI
Middle Name:
Last Name:YOSHINO
Suffix:
Gender:M
Credentials:DPT, AT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16253 LAGUNA CANYON RD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3613
Mailing Address - Country:US
Mailing Address - Phone:949-754-1344
Mailing Address - Fax:949-754-1351
Practice Address - Street 1:16253 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3605
Practice Address - Country:US
Practice Address - Phone:949-754-1344
Practice Address - Fax:949-754-1350
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT7583AMedicare UPIN