Provider Demographics
NPI:1306437967
Name:MIZUNO, KYOKA
Entity type:Individual
Prefix:
First Name:KYOKA
Middle Name:
Last Name:MIZUNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43000 MIDWAY AVE # 595
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92140-5692
Mailing Address - Country:US
Mailing Address - Phone:619-524-4006
Mailing Address - Fax:
Practice Address - Street 1:43000 MIDWAY AVE # 595
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5692
Practice Address - Country:US
Practice Address - Phone:619-524-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist