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General NPI Number Information
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NPI Number | 1003219064
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Entity Type | Individual
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Provider Name | TOMOKO WADA DDS
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Gender | Female
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 925 W 34TH ST STE 127 OSTROW SCHOOL OF DENTISTRY OF USC
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City | LOS ANGELES
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State | CA
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Zip | 90089-0058
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Country | US
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Telephone | 213-740-3410
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Fax | 213-740-3573
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Provider Business Mailing Address
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Address Line | 925 W 34TH ST STE 127 OSTROW SCHOOL OF DENTISTRY OF USC
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City | LOS ANGELES
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State | CA
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Zip | 90089-0641
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Country | US
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Telephone | 213-740-3410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 64110
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60264061
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License Number State | WA
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