Provider Demographics
NPI:1821264664
Name:TSUTSUI, FRED SHOJI (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:SHOJI
Last Name:TSUTSUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3640 LOMITA BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3957
Mailing Address - Country:US
Mailing Address - Phone:310-791-1790
Mailing Address - Fax:310-791-1062
Practice Address - Street 1:3640 LOMITA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3957
Practice Address - Country:US
Practice Address - Phone:310-791-1790
Practice Address - Fax:310-791-1062
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261371223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics