Healthcare Provider Details

I. General information

NPI: 1265822449
Provider Name (Legal Business Name): ALAN IGASAKI, DDS INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22850 CRENSHAW BLVD SUITE 102
TORRANCE CA
90505-3045
US

IV. Provider business mailing address

22850 CRENSHAW BLVD SUITE 102
TORRANCE CA
90505-3045
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-8282
  • Fax: 310-534-1850
Mailing address:
  • Phone: 310-534-8282
  • Fax: 310-534-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number39656
License Number StateCA

VIII. Authorized Official

Name: DR. ALAN IGASAKI
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-534-8282