Healthcare Provider Details

I. General information

NPI: 1811999519
Provider Name (Legal Business Name): MUNEKUNI OKAMOTO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E 2ND ST SUITE 301
LOS ANGELES CA
90012-4222
US

IV. Provider business mailing address

316 E 2ND ST SUITE 301
LOS ANGELES CA
90012-4222
US

V. Phone/Fax

Practice location:
  • Phone: 213-680-9935
  • Fax: 213-620-0010
Mailing address:
  • Phone: 213-680-9935
  • Fax: 213-620-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53092
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: