Provider Demographics
NPI:1467431601
Name:YANAGIDA, MASAO (MD)
Entity Type:Individual
Prefix:
First Name:MASAO
Middle Name:
Last Name:YANAGIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W BENSON BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3677
Mailing Address - Country:US
Mailing Address - Phone:907-929-4009
Mailing Address - Fax:
Practice Address - Street 1:1400 W BENSON BLVD STE 315
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3677
Practice Address - Country:US
Practice Address - Phone:907-929-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK59732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK34631Medicaid
AK34631Medicaid