Provider Demographics
NPI:1790768299
Name:YAMASHITA, MARY WOO (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WOO
Last Name:YAMASHITA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-8541
Mailing Address - Fax:323-442-8755
Practice Address - Street 1:1500 SAN PABLO ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-8541
Practice Address - Fax:323-442-8755
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG813042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00404583OtherMEDICARE RAILROAD CARRIER
CA00G813400OtherBLUE SHIELD RENDERING PRO
CA00G813040Medicaid
CAP00404583OtherMEDICARE RAILROAD CARRIER
CAWG81340JMedicare PIN
CA00G813040Medicaid
G78857Medicare UPIN
CA00G813400OtherBLUE SHIELD RENDERING PRO