=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629260369
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HIDEMI OKA DMD MD MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2007
-----------------------------------------------------
Last Update Date | 08/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33800 ALVARADO NILES ROAD #4
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-487-2040
-----------------------------------------------------
Fax | 510-471-9156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33800 ALVARADO NILES ROAD #4
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-487-2040
-----------------------------------------------------
Fax | 510-471-9156
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | A91565
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 70-OMS
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------