Provider Demographics
NPI:1285783076
Name:YANASE, REX RYUICHI (DDS)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:RYUICHI
Last Name:YANASE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22330 HAWTHORNE BLVD STE 316
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2590
Mailing Address - Country:US
Mailing Address - Phone:310-378-4244
Mailing Address - Fax:310-378-0164
Practice Address - Street 1:22330 HAWTHORNE BLVD STE 316
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2590
Practice Address - Country:US
Practice Address - Phone:310-378-4244
Practice Address - Fax:310-378-0164
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice