MEDICARE: DR. KRISTIN M. MORIGUCHI D.D.S.

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	100852	CA

General Provider Information

NPI Number	:	1831571694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN M. MORIGUCHI D.D.S.

Provider Business Mailing Address
First Line	:	12211 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1134
Country	:	US
Telephone Number	:	310-826-6123
Fax Number	:

Provider Business Practice Location Address
First Line	:	12211 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1134
Country	:	US
Telephone Number	:	310-826-6123
Fax Number	:

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

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	10/26/2016

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