Provider Demographics
NPI:1982828562
Name:TOMODA, YUKINOBU TOM (DDS)
Entity Type:Individual
Prefix:DR
First Name:YUKINOBU
Middle Name:TOM
Last Name:TOMODA
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 1:15474 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4325
Mailing Address - Country:US
Mailing Address - Phone:310-538-1233
Mailing Address - Fax:310-329-4666
Practice Address - Street 1:15474 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4325
Practice Address - Country:US
Practice Address - Phone:310-538-1233
Practice Address - Fax:310-329-4666
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist