Healthcare Provider Details

I. General information

NPI: 1699906586
Provider Name (Legal Business Name): KATSUKO MATSUI INC. A PROFESSIONAL DENTAL COOPERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5631 LINCOLN AVE
CYPRESS CA
90630-3156
US

IV. Provider business mailing address

5631 LINCOLN AVE
CYPRESS CA
90630-3156
US

V. Phone/Fax

Practice location:
  • Phone: 714-995-2040
  • Fax: 714-995-2081
Mailing address:
  • Phone: 714-995-2040
  • Fax: 714-995-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number44339
License Number StateCA

VIII. Authorized Official

Name: MS. KATSUKO MATSUI
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-995-2040