Provider Demographics
NPI:1841327467
Name:NOGUCHI, BRIAN SHINICHI (BRIAN NOGUCHI, DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SHINICHI
Last Name:NOGUCHI
Suffix:
Gender:M
Credentials:BRIAN NOGUCHI, DDS
Other - Prefix:DR
Other - First Name:SHINICHI
Other - Middle Name:BRIAN
Other - Last Name:NOGUCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BRIAN NOGUCHI, DDS
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:#430
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-540-2113
Mailing Address - Fax:310-540-2114
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:#430
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-540-2113
Practice Address - Fax:310-540-2114
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA339641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics