Provider Demographics
NPI:1730356031
Name:KAREN YAMAGUCHI, DPM, PA
Entity type:Organization
Organization Name:KAREN YAMAGUCHI, DPM, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:YAMAGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-722-7778
Mailing Address - Street 1:6999 MCPHERSON RD.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6837
Mailing Address - Country:US
Mailing Address - Phone:956-722-7778
Mailing Address - Fax:956-722-2353
Practice Address - Street 1:6999 MCPHERSON RD.
Practice Address - Street 2:SUITE 107
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6837
Practice Address - Country:US
Practice Address - Phone:956-722-7778
Practice Address - Fax:956-722-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1528213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140993002Medicaid
TX0082FAOtherBC/BS PROVIDER NUMBER
TX5863340001Medicare NSC
TX0A4524Medicare PIN
TX140993002Medicaid