Provider Demographics
NPI:1427192947
Name:YOSHIMURA, AUDRA (OD)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:YOSHIMURA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E COLORADO BLVD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2103
Mailing Address - Country:US
Mailing Address - Phone:310-202-6204
Mailing Address - Fax:310-202-0831
Practice Address - Street 1:800 E COLORADO BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2103
Practice Address - Country:US
Practice Address - Phone:310-202-6204
Practice Address - Fax:310-202-0831
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10669T207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU71970Medicare UPIN
CAWOP10669AMedicare ID - Type UnspecifiedMEDICARE PPIN#