Basic Information
Provider Information
NPI: 1114242401
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YONEMURA
FirstName: JANA
MiddleName: AKEMI
NamePrefix: MS.
NameSuffix:  
Credential: MS, OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8717 VENICE BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900343216
CountryCode: US
TelephoneNumber: 3103377115
FaxNumber: 3102166153
Practice Location
Address1: 6315 ARIZONA PL
Address2: SUITE A
City: LOS ANGELES
State: CA
PostalCode: 900451252
CountryCode: US
TelephoneNumber: 3103377115
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/30/2010
LastUpdateDate: 03/30/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XP0200XOT 10748CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics

No ID Information.


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