Healthcare Provider Details

I. General information

NPI: 1669685277
Provider Name (Legal Business Name): HAROLD HARUO ITOKAZU JR. D.D.S., L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 DE LONG AVE SUITE 100
NOVATO CA
94945-3246
US

IV. Provider business mailing address

800 DE LONG AVE SUITE 100
NOVATO CA
94945-3246
US

V. Phone/Fax

Practice location:
  • Phone: 415-786-5005
  • Fax: 415-892-8962
Mailing address:
  • Phone: 415-786-5005
  • Fax: 415-892-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41264
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: