Provider Demographics
NPI:1811076219
Name:SHIBUYA, ARNOLD TAKAICHI (DDS)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:TAKAICHI
Last Name:SHIBUYA
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 1:2665 HONOLULU AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1726
Mailing Address - Country:US
Mailing Address - Phone:818-957-1238
Mailing Address - Fax:
Practice Address - Street 1:133 S HUDSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2614
Practice Address - Country:US
Practice Address - Phone:626-793-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics