Healthcare Provider Details

I. General information

NPI: 1407008444
Provider Name (Legal Business Name): BRIAN TATSUO OKAMOTO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 TORRANCE BLVD SUITE 401
TORRANCE CA
90503-4409
US

IV. Provider business mailing address

4305 TORRANCE BOULEVARD. SUITE 401
TORRANCE CA
90503-4495
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-2547
  • Fax: 310-370-2548
Mailing address:
  • Phone: 310-370-2547
  • Fax: 310-370-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number35437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: