Provider Demographics
NPI:1497880272
Name:YAMADA, KENNETH TORU (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:TORU
Last Name:YAMADA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4346 REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1031
Mailing Address - Country:US
Mailing Address - Phone:310-370-5744
Mailing Address - Fax:310-542-4220
Practice Address - Street 1:4346 REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1031
Practice Address - Country:US
Practice Address - Phone:310-370-5744
Practice Address - Fax:310-542-4220
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8053T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist