Active NPI
Jon Derek Yatsushiro, D.D.S.
- Endodontics
- Gresham, OR
National Provider Identifier
1265505408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D7505
- Practice address
- 320 NE 5TH St
Gresham, OR 97030-7308 - Phone
- (503) 665-0495
- Fax
- (503) 674-9196
- NPI assigned
- Nov 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D7505 | OR | Primary |
| Endodontics | 1223E0200X | 1571 | HI | |
| Endodontics | 1223E0200X | 35662 | CA |
Addresses
Primary practice location
320 NE 5TH St
Gresham, OR 97030-7308
Mailing address
320 NE 5TH St
Gresham, OR 97030-7308
Phone (503) 665-0495
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7505 | OR | MD | Endodontist |
| 35662 | CA | MD | Pharmacist |
| 1571 | HI | MD | Vascular Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470182400000",
"number": "1265505408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 NE 5TH ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970307308",
"telephone_number": "503-665-0495",
"fax_number": "503-674-9196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 NE 5TH ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970307308",
"telephone_number": "503-665-0495",
"fax_number": "503-674-9196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YATSUSHIRO",
"first_name": "JON",
"middle_name": "DEREK",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-16",
"last_updated": "2016-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "OR",
"license": "D7505",
"primary": true
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "HI",
"license": "1571",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "35662",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.