Provider Demographics
NPI:1336328194
Name:YAMAMOTO, MAKI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAKI
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CITY BLVD W
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2903
Mailing Address - Country:US
Mailing Address - Phone:714-456-6847
Mailing Address - Fax:714-456-3967
Practice Address - Street 1:333 CITY BLVD W
Practice Address - Street 2:SUITE 1600
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2903
Practice Address - Country:US
Practice Address - Phone:714-456-6847
Practice Address - Fax:714-456-3967
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95898208600000X
FLME1102862086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology