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General NPI Number Information
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NPI Number | 1225210669
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Entity Type | Organization
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Legal Business Name | SHIBUYA & KINT DDS INC.
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 2452 FENTON ST SUITE #300
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City | CHULA VISTA
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State | CA
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Zip | 91914-3516
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Country | US
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Telephone | 619-946-4133
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Fax | 619-781-8547
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Provider Business Mailing Address
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Address Line | 2452 FENTON ST SUITE #300
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City | CHULA VISTA
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State | CA
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Zip | 91914-3516
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Country | US
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Telephone | 619-946-4133
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Fax | 619-781-8547
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Authorized Official
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Title or Position | SECRETARY
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Name | BURTON KINT
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Credential | DDS
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Telephone | 619-216-1811
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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 | 42835
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License Number State | CA
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