Provider Demographics
NPI:1568889061
Name:SUDO, YOJIRO (DC)
Entity Type:Individual
Prefix:DR
First Name:YOJIRO
Middle Name:
Last Name:SUDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17251 17TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1963
Mailing Address - Country:US
Mailing Address - Phone:714-584-5270
Mailing Address - Fax:
Practice Address - Street 1:17251 17TH ST STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1963
Practice Address - Country:US
Practice Address - Phone:714-584-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB213177Medicare PIN