Provider Demographics
NPI:1861775306
Name:KANAYAMA, NARIHIDE (DMD)
Entity type:Individual
Prefix:
First Name:NARIHIDE
Middle Name:
Last Name:KANAYAMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 DARTMOUTH ST # D4000
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2203
Mailing Address - Country:US
Mailing Address - Phone:626-999-6972
Mailing Address - Fax:
Practice Address - Street 1:3050 E 16TH ST # D4000
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2319
Practice Address - Country:US
Practice Address - Phone:510-535-4702
Practice Address - Fax:510-535-6557
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice