MEDICARE: MARUKO ORTHODONTICS INC

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	122300000X	Dentist	39838	CA

General Provider Information

NPI Number	:	1558434183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARUKO ORTHODONTICS INC

Provider Business Mailing Address
First Line	:	100 SOUTH FAIRMONT BLVD
Second Line	:
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	714-685-3890
Fax Number	:	714-685-3895

Provider Business Practice Location Address
First Line	:	100 SOUTH FAIRMONT BLVD
Second Line	:
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	714-685-3890
Fax Number	:	714-685-3895

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EVELYN YUMI MARUKO
Credential	:	DMD MS
Telephone Number	:	714-685-3890

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	08/22/2020

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