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General NPI Number Information
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NPI Number | 1356760169
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Entity Type | Individual
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Provider Name | DAI KITAMURA
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Gender | Male
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 1300 POTRERO GRANDE DRIVE #C
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City | ROSEMEAD
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State | CA
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Zip | 91770-2254
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Country | US
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Telephone | 626-288-1139
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Fax |
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Provider Business Mailing Address
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Address Line | 18229 DUSK STREET
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748
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Country | US
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Telephone | 626-991-1121
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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 | 62911
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License Number State | CA
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