Provider Demographics
NPI:1881889442
Name:KUMAMOTO, KINUKO LYN (DDS)
Entity type:Individual
Prefix:DR
First Name:KINUKO
Middle Name:LYN
Last Name:KUMAMOTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27762 VISTA DEL LAGO
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1137
Mailing Address - Country:US
Mailing Address - Phone:949-859-3109
Mailing Address - Fax:949-859-4936
Practice Address - Street 1:27762 VISTA DEL LAGO
Practice Address - Street 2:SUITE 9
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1137
Practice Address - Country:US
Practice Address - Phone:949-859-3109
Practice Address - Fax:949-859-4936
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice