MEDICARE: KAZUHIRO KATO DDS A DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	49905	CA

General Provider Information

NPI Number	:	1871798843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAZUHIRO KATO DDS A DENTAL CORP

Provider Business Mailing Address
First Line	:	3707 CONVOY STREET
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3754
Country	:	US
Telephone Number	:	858-565-1679
Fax Number	:	858-565-1863

Provider Business Practice Location Address
First Line	:	3707 CONVOY STREET
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3754
Country	:	US
Telephone Number	:	858-565-1679
Fax Number	:	858-565-1863

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KAZUHIRO KATO
Credential	:	DDS
Telephone Number	:	858-565-1679

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	08/29/2014

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