Provider Demographics
NPI:1437170099
Name:MORIGUCHI, GARY YUKIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:YUKIO
Last Name:MORIGUCHI
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 1:1295 E LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1703
Mailing Address - Country:US
Mailing Address - Phone:626-287-1153
Mailing Address - Fax:626-287-1456
Practice Address - Street 1:1295 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1703
Practice Address - Country:US
Practice Address - Phone:626-287-1153
Practice Address - Fax:626-287-1456
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice