Healthcare Provider Details

I. General information

NPI: 1164520227
Provider Name (Legal Business Name): DEAN YOSHITO MIZUNO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 E GREEN ST SUITE 310
PASADENA CA
91105-2070
US

IV. Provider business mailing address

87 E GREEN ST SUITE 310
PASADENA CA
91105-2070
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-4718
  • Fax: 626-796-1394
Mailing address:
  • Phone: 626-796-4718
  • Fax: 626-796-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: