Provider Demographics
NPI:1710088059
Name:HOMMA, YOSHIO (DC)
Entity Type:Individual
Prefix:DR
First Name:YOSHIO
Middle Name:
Last Name:HOMMA
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 1:430 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4209
Mailing Address - Country:US
Mailing Address - Phone:213-617-2228
Mailing Address - Fax:213-617-1734
Practice Address - Street 1:430 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4209
Practice Address - Country:US
Practice Address - Phone:213-617-2228
Practice Address - Fax:213-617-1734
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21369Medicare PIN
CAU60080Medicare UPIN