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General NPI Number Information
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NPI Number | 1811147796
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Entity Type | Organization
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Legal Business Name | KENNETH S. MASUMOTO DDS INC
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 430 W. SHAW
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City | FRESNO
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State | CA
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Zip | 93704
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Country | US
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Telephone | 559-229-1806
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Fax | 559-229-5953
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Provider Business Mailing Address
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Address Line | 430 W. SHAW
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City | FRESNO
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State | CA
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Zip | 93704
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Country | US
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Telephone | 559-229-1806
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Fax | 559-229-5953
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH SADAO MASUMOTO
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Credential | D.D.S.
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Telephone | 559-229-1806
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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 | 14139
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14139
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License Number State | CA
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