Healthcare Provider Details

I. General information

NPI: 1245734334
Provider Name (Legal Business Name): JEFFREY ASANO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N BRAND BLVD STE 302
GLENDALE CA
91203-4624
US

IV. Provider business mailing address

130 N BRAND BLVD STE 302
GLENDALE CA
91203-4624
US

V. Phone/Fax

Practice location:
  • Phone: 818-548-9668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number102849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: