Basic Information
| Provider Information | |||||||||
| NPI: | 1962531061 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YABUKI | ||||||||
| FirstName: | KEN | ||||||||
| MiddleName: | KEIJI | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11971 PEACH TREE RD | ||||||||
| Address2: | |||||||||
| City: | YUCAIPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923992759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094467178 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 340 N. MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442026 | ||||||||
| FaxNumber: | 3236442039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 12443 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.