Provider Demographics
NPI:1811440985
Name:YUKO MIYAZAKI DPM, INC
Entity type:Organization
Organization Name:YUKO MIYAZAKI DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIYAZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-647-3744
Mailing Address - Street 1:2999 REGENT ST,
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:510-647-3744
Mailing Address - Fax:510-764-2446
Practice Address - Street 1:2999 REGENT ST,
Practice Address - Street 2:SUITE 401
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-647-3744
Practice Address - Fax:510-764-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4911213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty