Provider Demographics
NPI:1891210001
Name:HIGA, JORDAN KOJI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:KOJI
Last Name:HIGA
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 1:1400 BARTON RD APT 408
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5484
Mailing Address - Country:US
Mailing Address - Phone:808-295-1624
Mailing Address - Fax:
Practice Address - Street 1:1047 HARRIMAN PL STE B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4203
Practice Address - Country:US
Practice Address - Phone:909-796-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist