Provider Demographics
NPI:1437790813
Name:JORDAN, ARIANNA YOSHIKO (OD)
Entity Type:Individual
Prefix:DR
First Name:ARIANNA
Middle Name:YOSHIKO
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12100 WILSHIRE BLVD STE 1275
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7143
Mailing Address - Country:US
Mailing Address - Phone:800-485-9196
Mailing Address - Fax:213-402-5261
Practice Address - Street 1:1042 PATAPSCO ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4595
Practice Address - Country:US
Practice Address - Phone:800-485-9196
Practice Address - Fax:213-402-5261
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist