MEDICARE: DR. TAKASHI KUMAMOTO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20392	CA

General Provider Information

NPI Number	:	1548473291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAKASHI KUMAMOTO DDS

Provider Business Mailing Address
First Line	:	1600 W REDONDO BEACH BLVD STE 306
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3229
Country	:	US
Telephone Number	:	310-768-4066
Fax Number	:	310-323-4383

Provider Business Practice Location Address
First Line	:	1600 W REDONDO BEACH BLVD STE 306
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3229
Country	:	US
Telephone Number	:	310-768-4066
Fax Number	:	310-323-4383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/26/2024

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