Basic Information
Provider Information | |||||||||
NPI: | 1811174071 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CHERYL M YOKOYAMA MD PS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 97115 | ||||||||
Address2: |   | ||||||||
City: | LAKEWOOD | ||||||||
State: | WA | ||||||||
PostalCode: | 984970115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535887911 | ||||||||
FaxNumber: | 2539846774 | ||||||||
Practice Location | |||||||||
Address1: | 2603 BRIDGEPORT WAY W STE F | ||||||||
Address2: |   | ||||||||
City: | UNIVERSITY PLACE | ||||||||
State: | WA | ||||||||
PostalCode: | 984664724 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535644073 | ||||||||
FaxNumber: | 2535660219 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/29/2008 | ||||||||
LastUpdateDate: | 11/24/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | YOKOYAMA | ||||||||
AuthorizedOfficialFirstName: | CHERYL | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
AuthorizedOfficialTelephone: | 2535644073 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1101X | MD00024872 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Ophthalmic Assistant |
ID Information
ID | Type | State | Issuer | Description | 1114420 | 05 | WA |   | MEDICAID |