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General NPI Number Information
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NPI Number | 1407063852
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Entity Type | Organization
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Legal Business Name | FRED H. MATSUMOTO D.D.S., INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11416 SOUTH ST
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City | CERRITOS
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State | CA
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Zip | 90703-6611
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Country | US
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Telephone | 562-860-5597
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Fax | 562-809-1947
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Provider Business Mailing Address
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Address Line | 11416 SOUTH ST
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City | CERRITOS
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State | CA
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Zip | 90703-6611
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Country | US
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Telephone | 562-860-5597
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Fax | 562-809-1947
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED HIROSHI MATSUMOTO
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Credential | D.D.S.
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Telephone | 562-860-5597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19932
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License Number State | CA
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