Provider Demographics
NPI:1437373933
Name:KITADA, DAVID K (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:KITADA
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 1:11500 W OLYMPIC BLVD
Mailing Address - Street 2:#424
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1527
Mailing Address - Country:US
Mailing Address - Phone:310-473-6114
Mailing Address - Fax:310-473-6024
Practice Address - Street 1:11500 W OLYMPIC BLVD
Practice Address - Street 2:#424
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1527
Practice Address - Country:US
Practice Address - Phone:310-473-6114
Practice Address - Fax:310-473-6024
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist