Provider Demographics
NPI:1992873061
Name:YOSHIZAWA, KOJI (DC)
Entity type:Individual
Prefix:
First Name:KOJI
Middle Name:
Last Name:YOSHIZAWA
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 1:4120 BIRCH STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-221-0267
Mailing Address - Fax:949-752-0174
Practice Address - Street 1:4120 BIRCH STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-221-0267
Practice Address - Fax:949-752-0174
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC25197Medicare ID - Type Unspecified
U99599Medicare UPIN