Provider Demographics
NPI:1538459649
Name:TAKASHI YAMAMOTO L.AC. PC
Entity Type:Organization
Organization Name:TAKASHI YAMAMOTO L.AC. PC
Other - Org Name:YAMAMOTO ORIENTAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAKASHI
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-480-9697
Mailing Address - Street 1:1765 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4342
Mailing Address - Country:US
Mailing Address - Phone:503-480-9697
Mailing Address - Fax:503-588-4133
Practice Address - Street 1:1765 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4342
Practice Address - Country:US
Practice Address - Phone:503-480-9697
Practice Address - Fax:503-588-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty