Provider Demographics
NPI:1821232042
Name:SHIMOZONO, YASUO RICHARD (RPT)
Entity Type:Individual
Prefix:MR
First Name:YASUO
Middle Name:RICHARD
Last Name:SHIMOZONO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HAMMOND
Mailing Address - Street 2:UNIT C
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1680
Mailing Address - Country:US
Mailing Address - Phone:949-770-6022
Mailing Address - Fax:949-770-7084
Practice Address - Street 1:5810 DOWNEY AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4517
Practice Address - Country:US
Practice Address - Phone:562-398-0200
Practice Address - Fax:569-398-0201
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist