Provider Demographics
NPI:1063684058
Name:ASANO, JOHN SEIICHI (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SEIICHI
Last Name:ASANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N BRAND BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2694
Mailing Address - Country:US
Mailing Address - Phone:818-548-9668
Mailing Address - Fax:818-548-9230
Practice Address - Street 1:130 N BRAND BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2694
Practice Address - Country:US
Practice Address - Phone:818-548-9668
Practice Address - Fax:818-548-9230
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0340481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice