Provider Demographics
NPI:1790855120
Name:HENJYOJI, EDWARD Y (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:Y
Last Name:HENJYOJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:351 ROLLING OAKS DR
Mailing Address - Street 2:#101
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1278
Mailing Address - Country:US
Mailing Address - Phone:805-449-4194
Mailing Address - Fax:805-497-6144
Practice Address - Street 1:351 ROLLING OAKS DR
Practice Address - Street 2:#101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1278
Practice Address - Country:US
Practice Address - Phone:805-449-4194
Practice Address - Fax:805-497-6144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC329722086S0122X
CAC-329722086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0210291OtherTIN
CAC32972Medicare PIN
CA77-0210291OtherTIN