Provider Demographics
NPI:1407864523
Name:HARADA, KEN MORRISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:MORRISON
Last Name:HARADA
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 1:10874 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice