Provider Demographics
NPI:1144379421
Name:S DAN KOYAMA DDS INC
Entity Type:Organization
Organization Name:S DAN KOYAMA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIZUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-974-4202
Mailing Address - Street 1:PO BOX 17668
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-7668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5591 E SANTA ANA CANYON ROAD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3149
Practice Address - Country:US
Practice Address - Phone:714-974-4202
Practice Address - Fax:714-974-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty