Provider Demographics
NPI:1548473291
Name:KUMAMOTO, TAKASHI (DDS)
Entity type:Individual
Prefix:DR
First Name:TAKASHI
Middle Name:
Last Name:KUMAMOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W REDONDO BEACH BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3229
Mailing Address - Country:US
Mailing Address - Phone:310-768-4066
Mailing Address - Fax:310-323-4383
Practice Address - Street 1:1600 W REDONDO BEACH BLVD STE 306
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3229
Practice Address - Country:US
Practice Address - Phone:310-768-4066
Practice Address - Fax:310-323-4383
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA203921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice