Provider Demographics
NPI:1043210735
Name:J.Y. TOKUYAMA, D.D.S. AND L.E. HANSEN, D.D.S., A PROFESSIONAL CORPORAT
Entity Type:Organization
Organization Name:J.Y. TOKUYAMA, D.D.S. AND L.E. HANSEN, D.D.S., A PROFESSIONAL CORPORAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-527-3306
Mailing Address - Street 1:1987 ROYAL AVE
Mailing Address - Street 2:# 4
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4655
Mailing Address - Country:US
Mailing Address - Phone:805-527-3306
Mailing Address - Fax:805-578-6529
Practice Address - Street 1:1987 ROYAL AVE
Practice Address - Street 2:# 4
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4655
Practice Address - Country:US
Practice Address - Phone:805-527-3306
Practice Address - Fax:805-578-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473711223G0001X
CA362031223G0001X
CA245061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty