Provider Demographics
NPI:1487743688
Name:WAKAMOTO, KAREN YEE (MPT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:YEE
Last Name:WAKAMOTO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 BOSTONIAN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4444
Mailing Address - Country:US
Mailing Address - Phone:562-430-5484
Mailing Address - Fax:
Practice Address - Street 1:18331 GRIDLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5438
Practice Address - Country:US
Practice Address - Phone:563-860-3662
Practice Address - Fax:562-860-4377
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT17984AMedicare PIN
CAW20329Medicare UPIN