Provider Demographics
NPI:1326243486
Name:NAKJIRI, TARA J (DDS DENTIST)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:J
Last Name:NAKJIRI
Suffix:
Gender:F
Credentials:DDS DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N ROXBURY DR
Mailing Address - Street 2:# NPH
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-271-0461
Mailing Address - Fax:310-271-1821
Practice Address - Street 1:436 N ROXBURY DR
Practice Address - Street 2:# NPH
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-271-0461
Practice Address - Fax:310-271-1821
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist