Provider Demographics
NPI:1467865238
Name:ITOH DENTAL CORPORATION
Entity Type:Organization
Organization Name:ITOH DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KOUICHI
Authorized Official - Middle Name:CLIFF
Authorized Official - Last Name:ITOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-687-3895
Mailing Address - Street 1:400 E 2ND ST
Mailing Address - Street 2:STE. 207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4228
Mailing Address - Country:US
Mailing Address - Phone:213-687-3895
Mailing Address - Fax:213-687-1016
Practice Address - Street 1:400 E 2ND ST
Practice Address - Street 2:STE. 207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4228
Practice Address - Country:US
Practice Address - Phone:213-687-3895
Practice Address - Fax:213-687-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty