Provider Demographics
NPI:1649205162
Name:MITCHELL Y. OUCHI D.D.S. INC.
Entity Type:Organization
Organization Name:MITCHELL Y. OUCHI D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:YOSHIAKI
Authorized Official - Last Name:OUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-266-6262
Mailing Address - Street 1:105 S ROWAN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2400
Mailing Address - Country:US
Mailing Address - Phone:323-266-6262
Mailing Address - Fax:
Practice Address - Street 1:105 S ROWAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2400
Practice Address - Country:US
Practice Address - Phone:323-266-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24580261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental