Healthcare Provider Details

I. General information

NPI: 1912522905
Provider Name (Legal Business Name): ANNIE WAKI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE TSUCHIYAMA DDS

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E COLUMBIA ST STE 32
LONG BEACH CA
90806-1607
US

IV. Provider business mailing address

4071 LOMA ST
IRVINE CA
92604-2203
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-3141
  • Fax:
Mailing address:
  • Phone: 925-212-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number107408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: