Provider Demographics
NPI:1811143142
Name:YAMAMOTO, MAKIKO (LAC)
Entity type:Individual
Prefix:
First Name:MAKIKO
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W MEDICINE LAKE DR APT 113
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4837
Mailing Address - Country:US
Mailing Address - Phone:612-968-9570
Mailing Address - Fax:
Practice Address - Street 1:125 MAIN ST SE STE 237
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2278
Practice Address - Country:US
Practice Address - Phone:612-378-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1316171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist