Provider Demographics
NPI:1073620381
Name:HIGASHIYAMA, ROBERT TOM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TOM
Last Name:HIGASHIYAMA
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 1:4010 SEPULVEDA BL
Mailing Address - Street 2:STE 1
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-378-6218
Mailing Address - Fax:310-791-4047
Practice Address - Street 1:4010 SEPULVEDA BL
Practice Address - Street 2:STE 1
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-378-6218
Practice Address - Fax:310-791-4047
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice