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General NPI Number Information
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NPI Number | 1891210001
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Entity Type | Individual
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Provider Name | JORDAN KOJI HIGA DDS
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Gender | Male
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 1047 HARRIMAN PL STE B
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-4203
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Country | US
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Telephone | 909-796-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 BARTON RD APT 408
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City | REDLANDS
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State | CA
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Zip | 92373-5484
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Country | US
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Telephone | 808-295-1624
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 101753
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License Number State | CA
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