=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568682151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY H. KUWABARA, D.D.S., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 10/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16960 BASTANCHURY RD SUITE B
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92886-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-986-1699
-----------------------------------------------------
Fax | 714-986-1690
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16960 BASTANCHURY RD SUITE B
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92886-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-986-1699
-----------------------------------------------------
Fax | 714-986-1690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, OWNER
-----------------------------------------------------
Name | DR. GREGORY H. KUWABARA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 714-986-1699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 34455
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------