Provider Demographics
NPI:1033255435
Name:RANDALL T KANEMAKI DDS INC
Entity Type:Organization
Organization Name:RANDALL T KANEMAKI DDS INC
Other - Org Name:RANDALL T KANEMAKI DDS RANDALL T KANEMAKI DR KANEMAKI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KANEMAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-827-2545
Mailing Address - Street 1:8751 VALLEY VIEW STREET
Mailing Address - Street 2:SUITE #B
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620
Mailing Address - Country:US
Mailing Address - Phone:714-827-2545
Mailing Address - Fax:714-827-0506
Practice Address - Street 1:8751 VALLEY VIEW STREET
Practice Address - Street 2:SUITE #B
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620
Practice Address - Country:US
Practice Address - Phone:714-827-2545
Practice Address - Fax:714-827-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty