Provider Demographics
NPI:1568507663
Name:KODA, LEONARD YOSHIO (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:YOSHIO
Last Name:KODA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 WILLOWSPRING DR N
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1916
Mailing Address - Country:US
Mailing Address - Phone:760-753-5213
Mailing Address - Fax:
Practice Address - Street 1:120 CRAVEN ROAD
Practice Address - Street 2:100
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4236
Practice Address - Country:US
Practice Address - Phone:760-750-4021
Practice Address - Fax:760-750-3181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39200183500000X
UT1406601701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist