Provider Demographics
NPI:1962717637
Name:KIMURA, JENNIFER KIMIKO (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KIMIKO
Last Name:KIMURA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 BLOOMFIELD ST STE 30
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6739
Mailing Address - Country:US
Mailing Address - Phone:562-353-4541
Mailing Address - Fax:562-353-4771
Practice Address - Street 1:10621 BLOOMFIELD ST STE 30
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6739
Practice Address - Country:US
Practice Address - Phone:562-353-4541
Practice Address - Fax:562-353-4771
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice