Provider Demographics
NPI:1043651383
Name:CANDICE R. JOHNSON DDS BRIAN K. SHIMIZU DDS
Entity Type:Organization
Organization Name:CANDICE R. JOHNSON DDS BRIAN K. SHIMIZU DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-594-7100
Mailing Address - Street 1:5512 E BRITTON DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3146
Mailing Address - Country:US
Mailing Address - Phone:562-594-7100
Mailing Address - Fax:562-594-8800
Practice Address - Street 1:5512 E BRITTON DR
Practice Address - Street 2:SUITE 208
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3146
Practice Address - Country:US
Practice Address - Phone:562-594-7100
Practice Address - Fax:562-594-8800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANDICE R. JOHNSON DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty