Provider Demographics
NPI:1518997527
Name:YASUDA, RODERICK K (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:K
Last Name:YASUDA
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 1:18350 ROSCOE BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4148
Mailing Address - Country:US
Mailing Address - Phone:818-993-4471
Mailing Address - Fax:818-993-7565
Practice Address - Street 1:18350 ROSCOE BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4148
Practice Address - Country:US
Practice Address - Phone:818-993-4471
Practice Address - Fax:818-993-7565
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019055208G00000X
CAG54353208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2200852Medicaid
CAWG54353BMedicare PIN