Healthcare Provider Details

I. General information

NPI: 1285427005
Provider Name (Legal Business Name): JOSE IWAKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE IWAKI HONORE

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 FLORENCE AVE
BELL CA
90201-3403
US

IV. Provider business mailing address

PO BOX 1287
CYPRESS CA
90630-6287
US

V. Phone/Fax

Practice location:
  • Phone: 323-560-6096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: