Provider Demographics
NPI:1811999519
Name:OKAMOTO, MUNEKUNI (DDS)
Entity type:Individual
Prefix:DR
First Name:MUNEKUNI
Middle Name:
Last Name:OKAMOTO
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:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4222
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:SUITE 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4222
Practice Address - Country:US
Practice Address - Phone:213-680-9935
Practice Address - Fax:213-620-0010
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53092122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice