Provider Demographics
NPI:1790790194
Name:CARL Y. YAMAGUCHI DDS APC
Entity Type:Organization
Organization Name:CARL Y. YAMAGUCHI DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:YUKIO
Authorized Official - Last Name:YAMAGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-440-9211
Mailing Address - Street 1:1276 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3036
Mailing Address - Country:US
Mailing Address - Phone:619-440-9211
Mailing Address - Fax:
Practice Address - Street 1:1276 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3036
Practice Address - Country:US
Practice Address - Phone:619-440-9211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty