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General NPI Number Information
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NPI Number | 1811076219
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Entity Type | Individual
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Provider Name | ARNOLD TAKAICHI SHIBUYA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 133 S HUDSON AVE STE 1
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City | PASADENA
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State | CA
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Zip | 91101-2614
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Country | US
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Telephone | 626-793-0279
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Fax |
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Provider Business Mailing Address
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Address Line | 2665 HONOLULU AVE APT 16
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City | MONTROSE
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State | CA
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Zip | 91020-1726
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Country | US
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Telephone | 818-957-1238
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 20588
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License Number State | CA
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