Provider Demographics
NPI:1750634713
Name:KUMATA, CONRAD KIYOSHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:KIYOSHI
Last Name:KUMATA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10251 TORRE AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2186
Mailing Address - Country:US
Mailing Address - Phone:408-257-3320
Mailing Address - Fax:
Practice Address - Street 1:10251 TORRE AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2186
Practice Address - Country:US
Practice Address - Phone:408-257-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice