Basic Information
| Provider Information | |||||||||
| NPI: | 1902038318 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK W. YAMAZAKI M.D. INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4148 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905104148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107923914 | ||||||||
| FaxNumber: | 3107923802 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 PARK TER | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900451543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106657150 | ||||||||
| FaxNumber: | 3106657171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 08/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | YAMAZAKI | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3107923914 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G19080 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.