Provider Demographics
NPI:1649338070
Name:OTA, FRANK YUKIO (LAC)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:YUKIO
Last Name:OTA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1976 S SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5620
Mailing Address - Country:US
Mailing Address - Phone:310-473-2971
Mailing Address - Fax:310-473-7372
Practice Address - Street 1:1976 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5620
Practice Address - Country:US
Practice Address - Phone:310-473-2971
Practice Address - Fax:310-473-7372
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist