Seth David Ichikawa, D.D.S.
Individual provider Active NPI Dentist · McClellan, CA
NPI 1326470709 · NPPES record last updated Jul 16, 2019
Key facts
- NPI
- 1326470709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 62679 (CA)
- Practice address
- 5401 Arnold Ave BLDG 88
McClellan, CA 95652-1018 - Phone
- (916) 333-5500
- NPI assigned
- Aug 7, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 62679 | CA | Yes |
Addresses
Primary practice location
5401 Arnold Ave BLDG 88
McClellan, CA 95652-1018
Mailing address
5401 Arnold Ave BLDG 88
McClellan, CA 95652-1018
Phone (916) 333-5500
Other providers in McClellan, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.