Provider Demographics
NPI:1194732115
Name:YOSHIMARU, DAVID H (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:YOSHIMARU
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 1:1304 15TH ST.
Mailing Address - Street 2:SUITE 324
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-394-3631
Mailing Address - Fax:310-393-4631
Practice Address - Street 1:1304 15TH ST
Practice Address - Street 2:SUITE 324
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1809
Practice Address - Country:US
Practice Address - Phone:310-394-3631
Practice Address - Fax:310-393-4631
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38779OtherLICENSE #
CA954373486OtherTAX ID #
CABY2576164OtherDEA #