=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114058161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHOICHI OHGI DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6850 BROCKTON AVE 104
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92506-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-683-4397
-----------------------------------------------------
Fax | 951-684-0265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6850 BROCKTON AVE 104
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92506-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-683-4397
-----------------------------------------------------
Fax | 951-684-0265
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHOICHI OHGI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 951-683-4397
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 45744
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------