Provider Demographics
NPI:1699442426
Name:YOSHIHARA, DUSTON
Entity type:Individual
Prefix:
First Name:DUSTON
Middle Name:
Last Name:YOSHIHARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 PERSIMMON LN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2814
Mailing Address - Country:US
Mailing Address - Phone:949-246-3753
Mailing Address - Fax:
Practice Address - Street 1:12 MAUCHLY STE P
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-6309
Practice Address - Country:US
Practice Address - Phone:949-232-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3008202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic