Provider Demographics
NPI:1629164736
Name:YAMAJI, KYOKO
Entity Type:Individual
Prefix:
First Name:KYOKO
Middle Name:
Last Name:YAMAJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13440 UNIVERSITY BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4909
Mailing Address - Country:US
Mailing Address - Phone:832-500-4321
Mailing Address - Fax:
Practice Address - Street 1:13440 UNIVERSITY BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4909
Practice Address - Country:US
Practice Address - Phone:832-500-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225711223S0112X
CO95481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery