Provider Demographics
NPI:1720205891
Name:ROBERT T. KIMURA D.M.D.
Entity Type:Organization
Organization Name:ROBERT T. KIMURA D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-207-6111
Mailing Address - Street 1:11980 SAN VICENTE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6603
Mailing Address - Country:US
Mailing Address - Phone:310-207-6111
Mailing Address - Fax:310-207-8083
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6603
Practice Address - Country:US
Practice Address - Phone:310-207-6111
Practice Address - Fax:310-207-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization