Provider Demographics
NPI:1972707677
Name:YAMANAKA, JEANINE (MD)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:YAMANAKA
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 1:850 S. ATLANTIC BLVD.
Mailing Address - Street 2:301
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 S. ATLANTIC BLVD.
Practice Address - Street 2:301
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4769
Practice Address - Country:US
Practice Address - Phone:626-289-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68698207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079700Medicaid
CA00A686980Medicaid
CAGR0079700Medicaid
CAH48724Medicare UPIN
CA00A686980Medicare ID - Type Unspecified