Healthcare Provider Details

I. General information

NPI: 1407922230
Provider Name (Legal Business Name): TOSHIYUKI JERRY OKUDA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 WEST 190TH STREET
TORRANCE CA
90503-1003
US

IV. Provider business mailing address

4970 WEST 190TH STREET
TORRANCE CA
90503-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-1272
  • Fax: 310-370-0124
Mailing address:
  • Phone: 310-370-1272
  • Fax: 310-370-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: