Provider Demographics
NPI:1336820406
Name:ANDREW K. IKAZAKI DDS
Entity Type:Organization
Organization Name:ANDREW K. IKAZAKI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:KEN
Authorized Official - Last Name:IKAZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-473-2727
Mailing Address - Street 1:11340 W OLYMPIC BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1624
Mailing Address - Country:US
Mailing Address - Phone:310-473-2727
Mailing Address - Fax:
Practice Address - Street 1:11340 W OLYMPIC BLVD STE 360
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1624
Practice Address - Country:US
Practice Address - Phone:310-473-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty