Provider Demographics
NPI:1265561062
Name:HATAKEYAMA, JON YONEO (DDS)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:YONEO
Last Name:HATAKEYAMA
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 1:370 W DUNNE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4846
Mailing Address - Country:US
Mailing Address - Phone:408-779-7391
Mailing Address - Fax:408-779-5081
Practice Address - Street 1:370 W DUNNE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4846
Practice Address - Country:US
Practice Address - Phone:408-779-7391
Practice Address - Fax:408-779-5081
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice