Provider Demographics
NPI:1720074537
Name:YAMAUCHI, PAUL STEVEN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEVEN
Last Name:YAMAUCHI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD 1160W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2120
Mailing Address - Country:US
Mailing Address - Phone:310-829-4104
Mailing Address - Fax:310-829-4150
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:#1160W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-829-4104
Practice Address - Fax:310-829-4150
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53239207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA53239DOtherBILLING
CAWA53239AOtherBILLING
CAY44972Medicare PIN
CAWA53239AOtherBILLING