Provider Demographics
NPI:1346843935
Name:YAMADA, POY SAKJIRAPAPONG (NP)
Entity Type:Individual
Prefix:DR
First Name:POY
Middle Name:SAKJIRAPAPONG
Last Name:YAMADA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19191 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1018
Mailing Address - Country:US
Mailing Address - Phone:310-316-0811
Mailing Address - Fax:
Practice Address - Street 1:18107 SHERMAN WAY STE 200
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-8802
Practice Address - Country:US
Practice Address - Phone:818-783-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty