=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497051494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER KURIMOTO D.D.S. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2011
-----------------------------------------------------
Last Update Date | 02/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1122 N BRAND BLVD STE 203
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91202-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-937-6700
-----------------------------------------------------
Fax | 818-937-6701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1122 N BRAND BLVD STE 203
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91202-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-937-6700
-----------------------------------------------------
Fax | 818-937-6701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CHRISTOPHER KURIMOTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-937-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 45480
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------