Provider Demographics
NPI:1811741077
Name:YIRAI, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:YIRAI
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 1:30238 SW 158TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3408
Mailing Address - Country:US
Mailing Address - Phone:786-624-1358
Mailing Address - Fax:
Practice Address - Street 1:30238 SW 158TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3408
Practice Address - Country:US
Practice Address - Phone:786-624-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician