Provider Demographics
NPI:1326064478
Name:YAMAGUCHI, CAMERON MASAO (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:MASAO
Last Name:YAMAGUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13652 CANTARA ST
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5423
Mailing Address - Country:US
Mailing Address - Phone:818-375-2000
Mailing Address - Fax:
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-375-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGROO16910OtherGROUP MEDICAID PIN
CAW11675OtherGROUP MEDICARE PIN
CA00A896030Medicaid
CA1356390009OtherGROUP NPI
CA00A896030197OtherCAL OPTIMA
CACE1617OtherGROUP RAILROAD MEDICARE
CA990005307OtherRAILROAD MEDICARE
CA00A896030OtherBLUE SHIELD
CAWA896603AMedicare PIN
CAW11675OtherGROUP MEDICARE PIN