Provider Demographics
NPI:1578753794
Name:RYAN A YAMANAKA DDS
Entity Type:Organization
Organization Name:RYAN A YAMANAKA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:AKIRA
Authorized Official - Last Name:YAMANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-443-8822
Mailing Address - Street 1:1378 CONCANNON BLVD
Mailing Address - Street 2:STE H
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6004
Mailing Address - Country:US
Mailing Address - Phone:925-443-8822
Mailing Address - Fax:925-443-6335
Practice Address - Street 1:1378 CONCANNON BLVD
Practice Address - Street 2:STE H
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6004
Practice Address - Country:US
Practice Address - Phone:925-443-8822
Practice Address - Fax:925-443-6335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD H YAMANAKA DDS, MSD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty