Basic Information
| Provider Information | |||||||||
| NPI: | 1023090784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOKOYAMA | ||||||||
| FirstName: | TARO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 W 3RD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900571932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136392200 | ||||||||
| FaxNumber: | 2133687739 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 W 3RD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900571932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136392200 | ||||||||
| FaxNumber: | 2133687739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 07/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | A25613 | CA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 00A256130 | 05 | CA | MEDICAID | 00A256130L95 | 05 | CA | MEDICAID | GR0026700 | 05 | CA | MEDICAID |