Healthcare Provider Details

I. General information

NPI: 1699912907
Provider Name (Legal Business Name): JILL SEKIGUCHI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E GREEN ST SUITE B
PASADENA CA
91106-2505
US

IV. Provider business mailing address

1121 E GREEN ST SUITE B
PASADENA CA
91106-2505
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-5566
  • Fax:
Mailing address:
  • Phone: 626-792-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: