Provider Demographics
NPI:1457575748
Name:YOSHIMURA, IWAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:IWAO
Middle Name:
Last Name:YOSHIMURA
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 1:316 E 2ND ST
Mailing Address - Street 2:#301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4221
Mailing Address - Country:US
Mailing Address - Phone:213-680-9935
Mailing Address - Fax:213-620-0010
Practice Address - Street 1:316 E 2ND ST
Practice Address - Street 2:#301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4221
Practice Address - Country:US
Practice Address - Phone:213-680-9935
Practice Address - Fax:213-620-0010
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice