Provider Demographics
NPI:1053989665
Name:YAMAMOTO, DAVID JOHN (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-6508
Mailing Address - Country:US
Mailing Address - Phone:310-322-8777
Mailing Address - Fax:310-322-8787
Practice Address - Street 1:2255 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-6508
Practice Address - Country:US
Practice Address - Phone:310-322-8777
Practice Address - Fax:310-322-8787
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor