1598830283 NPI number — DR. KIMBERLY HIROSHIGE OKUMURA DDS

Table of content: DR. KIMBERLY HIROSHIGE OKUMURA DDS (NPI 1598830283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598830283 NPI number — DR. KIMBERLY HIROSHIGE OKUMURA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIROSHIGE OKUMURA
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HIROSHIGE
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598830283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18700 MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-847-2507
Provider Business Mailing Address Fax Number:
714-842-7327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18700 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-847-2507
Provider Business Practice Location Address Fax Number:
714-842-7327
Provider Enumeration Date:
11/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  39008 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)