Provider Demographics
NPI:1972695864
Name:KITAZAWA, GARY NORIAKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:NORIAKI
Last Name:KITAZAWA
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 1:1127 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3905
Mailing Address - Country:US
Mailing Address - Phone:213-481-1127
Mailing Address - Fax:213-481-1510
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-481-1127
Practice Address - Fax:213-481-1510
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics