Healthcare Provider Details

I. General information

NPI: 1720205891
Provider Name (Legal Business Name): ROBERT T. KIMURA D.M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 SAN VICENTE BLVD STE 500
LOS ANGELES CA
90049-6603
US

IV. Provider business mailing address

11980 SAN VICENTE BLVD STE 500
LOS ANGELES CA
90049-6603
US

V. Phone/Fax

Practice location:
  • Phone: 310-207-6111
  • Fax: 310-207-8083
Mailing address:
  • Phone: 310-207-6111
  • Fax: 310-207-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT T. KIMURA
Title or Position: DR.
Credential: D.M.D.
Phone: 310-207-6111