Provider Demographics
NPI:1396846804
Name:NAKATSUKA, NED KAZUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:NED
Middle Name:KAZUO
Last Name:NAKATSUKA
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 1:27792 ALISO CREEK ROAD
Mailing Address - Street 2:B-170
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656
Mailing Address - Country:US
Mailing Address - Phone:949-360-1213
Mailing Address - Fax:949-360-7266
Practice Address - Street 1:27792 ALISO CREEK ROAD
Practice Address - Street 2:B-170
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656
Practice Address - Country:US
Practice Address - Phone:949-360-1213
Practice Address - Fax:949-360-7266
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA971555OtherUNITED CONCORDIA PROVIDER