Provider Demographics
NPI:1679616379
Name:ISHIOKA, SUSAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ISHIOKA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5122 KATELLA AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2826
Mailing Address - Country:US
Mailing Address - Phone:562-493-2807
Mailing Address - Fax:562-598-3332
Practice Address - Street 1:5122 KATELLA AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2826
Practice Address - Country:US
Practice Address - Phone:562-493-2807
Practice Address - Fax:562-598-3332
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA355061223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics