Provider Demographics
NPI:1558515742
Name:UCHIDA, JUSTIN (PA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:UCHIDA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W. WASHINGTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-6123
Mailing Address - Country:US
Mailing Address - Phone:323-728-3955
Mailing Address - Fax:323-728-6905
Practice Address - Street 1:815 W. WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-6123
Practice Address - Country:US
Practice Address - Phone:323-728-3955
Practice Address - Fax:323-728-6905
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20042363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical