Provider Demographics
NPI:1407922230
Name:OKUDA, TOSHIYUKI JERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOSHIYUKI
Middle Name:JERRY
Last Name:OKUDA
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 1:4970 WEST 190TH STREET
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1003
Mailing Address - Country:US
Mailing Address - Phone:310-370-1272
Mailing Address - Fax:310-370-0124
Practice Address - Street 1:4970 WEST 190TH STREET
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1003
Practice Address - Country:US
Practice Address - Phone:310-370-1272
Practice Address - Fax:310-370-0124
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25819483OtherEDD