Provider Demographics
NPI:1104093533
Name:OHARA, PATRICK KEIJI (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KEIJI
Last Name:OHARA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 E BEVERLY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-7001
Mailing Address - Country:US
Mailing Address - Phone:323-888-1192
Mailing Address - Fax:323-888-2009
Practice Address - Street 1:200 E BEVERLY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-7001
Practice Address - Country:US
Practice Address - Phone:323-888-1192
Practice Address - Fax:323-888-2009
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics