Healthcare Provider Details

I. General information

NPI: 1871642660
Provider Name (Legal Business Name): WARREN TADASHI TOFUKUJI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22330 HAWTHORNE BLVD SUITE #316
TORRANCE CA
90505-2536
US

IV. Provider business mailing address

22330 HAWTHORNE BLVD SUITE #316
TORRANCE CA
90505-2536
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-4244
  • Fax: 310-378-0164
Mailing address:
  • Phone: 310-378-4244
  • Fax: 310-378-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: