Provider Demographics
NPI:1558355024
Name:YAMASHITA, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:YAMASHITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2219 W OLIVE AVE
Mailing Address - Street 2:#219
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2625
Mailing Address - Country:US
Mailing Address - Phone:818-898-4412
Mailing Address - Fax:818-898-4419
Practice Address - Street 1:15031 RINALDI ST
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1207
Practice Address - Country:US
Practice Address - Phone:818-898-4412
Practice Address - Fax:818-898-4419
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG75497207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G754970Medicaid
CAWG75497CMedicare ID - Type Unspecified
CA00G754970Medicaid