Provider Demographics
NPI:1639380850
Name:YAMAGUCHI, SUSSI AI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSSI
Middle Name:AI
Last Name:YAMAGUCHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3759 FLORIDA ST UNIT M
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-7202
Mailing Address - Country:US
Mailing Address - Phone:858-342-9372
Mailing Address - Fax:619-444-9059
Practice Address - Street 1:226 AVOCADO AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4604
Practice Address - Country:US
Practice Address - Phone:619-444-4083
Practice Address - Fax:619-444-9059
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice