Provider Demographics
NPI:1417147737
Name:MIYAZAKI, YUKO (DPM)
Entity Type:Individual
Prefix:
First Name:YUKO
Middle Name:
Last Name:MIYAZAKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 REGENT ST STE 401
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2119
Mailing Address - Country:US
Mailing Address - Phone:510-647-3744
Mailing Address - Fax:510-764-2446
Practice Address - Street 1:2999 REGENT ST STE 401
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2119
Practice Address - Country:US
Practice Address - Phone:510-647-3744
Practice Address - Fax:510-764-2446
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4911213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery