Provider Demographics
NPI:1700343894
Name:YAMAMOTO, KAI GABRIEL GENUNG (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:GABRIEL GENUNG
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13372 CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4704
Mailing Address - Country:US
Mailing Address - Phone:714-640-4469
Mailing Address - Fax:
Practice Address - Street 1:2501 CHERRY AVE
Practice Address - Street 2:STE 250
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2041
Practice Address - Country:US
Practice Address - Phone:714-640-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist