Provider Demographics
NPI:1255491965
Name:KEN M. HARADA, D.D.S., INC.
Entity Type:Organization
Organization Name:KEN M. HARADA, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:MORRISON
Authorized Official - Last Name:HARADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-837-5121
Mailing Address - Street 1:10874 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3610
Mailing Address - Country:US
Mailing Address - Phone:310-837-5121
Mailing Address - Fax:310-837-9409
Practice Address - Street 1:10874 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3610
Practice Address - Country:US
Practice Address - Phone:310-837-5121
Practice Address - Fax:310-837-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty