Provider Demographics
NPI:1295917235
Name:YASUDA, DAVID SHINJI (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHINJI
Last Name:YASUDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 GREENHAVEN DR
Mailing Address - Street 2:120
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5129
Mailing Address - Country:US
Mailing Address - Phone:916-393-5900
Mailing Address - Fax:916-393-5999
Practice Address - Street 1:7400 GREENHAVEN DR
Practice Address - Street 2:120
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5129
Practice Address - Country:US
Practice Address - Phone:916-393-5900
Practice Address - Fax:916-393-5999
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist