Provider Demographics
NPI:1588712798
Name:TANAKA, KEVIN K (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
Last Name:TANAKA
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 1:1111 W TOWN AND COUNTRY RD
Mailing Address - Street 2:SUITE #22
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4615
Mailing Address - Country:US
Mailing Address - Phone:714-543-2505
Mailing Address - Fax:
Practice Address - Street 1:1111 W TOWN AND COUNTRY RD
Practice Address - Street 2:SUITE #22
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4615
Practice Address - Country:US
Practice Address - Phone:714-543-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist