Provider Demographics
NPI:1437133063
Name:KEITH C. HARADA, D.D.S., INC.
Entity Type:Organization
Organization Name:KEITH C. HARADA, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:CHITOSE
Authorized Official - Last Name:HARADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-726-1544
Mailing Address - Street 1:1717 W BEVERLY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3971
Mailing Address - Country:US
Mailing Address - Phone:323-726-1544
Mailing Address - Fax:323-726-3091
Practice Address - Street 1:1717 W BEVERLY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3971
Practice Address - Country:US
Practice Address - Phone:323-726-1544
Practice Address - Fax:323-726-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty