Provider Demographics
NPI:1669685277
Name:ITOKAZU, HAROLD HARUO JR (DDS, L AC)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:HARUO
Last Name:ITOKAZU
Suffix:JR
Gender:M
Credentials:DDS, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DE LONG AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3246
Mailing Address - Country:US
Mailing Address - Phone:415-786-5005
Mailing Address - Fax:415-892-8962
Practice Address - Street 1:800 DE LONG AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3246
Practice Address - Country:US
Practice Address - Phone:415-786-5005
Practice Address - Fax:415-892-8962
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41264122300000X
CAAC7367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered171100000XOther Service ProvidersAcupuncturist