Provider Demographics
NPI:1326170606
Name:MIYADI, DENNIS YEICHI (OTR)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:YEICHI
Last Name:MIYADI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 AVENUE SAUSALITO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1849
Mailing Address - Country:US
Mailing Address - Phone:714-401-5563
Mailing Address - Fax:949-733-9258
Practice Address - Street 1:3732 AVENUE SAUSALITO
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1849
Practice Address - Country:US
Practice Address - Phone:714-401-5563
Practice Address - Fax:949-733-9258
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT1912Medicare PIN