Provider Demographics
NPI:1326260019
Name:NAMBA, MICHAEL MASAMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MASAMI
Last Name:NAMBA
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 1:3671 FARQUHAR AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3966
Mailing Address - Country:US
Mailing Address - Phone:562-598-7267
Mailing Address - Fax:
Practice Address - Street 1:3532 HOWARD AVE STE 203
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3695
Practice Address - Country:US
Practice Address - Phone:562-598-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice