Provider Demographics
NPI:1700940335
Name:ICHIUJI, ARNOLD TSUTOMU (DMD)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:TSUTOMU
Last Name:ICHIUJI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WEST SIXTH STREET
Mailing Address - Street 2:STE A
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-842-0365
Mailing Address - Fax:408-842-1081
Practice Address - Street 1:700 WEST SIXTH STREET
Practice Address - Street 2:STE A
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-842-0365
Practice Address - Fax:408-842-1081
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist