Iwamoto Enterprises, Inc.

Primary specialty

Dental LaboratoryTaxonomy code 292200000X

License

FAC00046448 Issued in CA

Legal business name

IWAMOTO ENTERPRISES, INC.

Doing business as

Golden State X-Ray

Practice address

5451 Laurel Canyon Blvd
Suite 202
Valley Village, CA 91607-2180

Phone

(818) 506-6861

Fax

(818) 506-3643

NPI assigned

Feb 4, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Eric Takeo Iwamoto

Title

Ceo/President

Phone

(818) 506-6861

Specialties & licenses 1

Addresses

Other names 1

• Golden State X-Ray Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423008000000",
    "number": "1023408580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5451 LAUREL CANYON BLVD",
            "address_2": "SUITE 202",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916072180",
            "telephone_number": "818-506-6861",
            "fax_number": "818-506-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5451 LAUREL CANYON BLVD",
            "address_2": "SUITE 202",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916072180",
            "telephone_number": "818-506-6861",
            "fax_number": "818-506-3643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IWAMOTO ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2015-02-04",
        "status": "A",
        "authorized_official_last_name": "IWAMOTO",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "TAKEO",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "818-506-6861",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "CA",
            "license": "FAC00046448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden State X-Ray",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Laboratory in Valley Village, CA
• Providers in Valley Village, CA by specialty
• Dental Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.