Provider Demographics
NPI:1457466674
Name:YOSHIYAMA, KERRI (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:
Last Name:YOSHIYAMA
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:UNIVERSITY OF CALIFORNIA BERKELEY SCHOOL OF
Mailing Address - Street 2:230 MINOR HALL
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-2020
Mailing Address - Country:US
Mailing Address - Phone:510-642-0945
Mailing Address - Fax:
Practice Address - Street 1:UC BERKELEY SCHOOL OF OPTOMETRY
Practice Address - Street 2:230 MINOR HALL
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-2020
Practice Address - Country:US
Practice Address - Phone:510-642-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12677152W00000X
WA00003899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW17649Medicare ID - Type Unspecified