NPIMap

Organization Active NPI

Kunimoto Dental Corp

  • General Practice Dentistry
  • Stockton, CA
National Provider Identifier
1508198680
Registry record updated Feb 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
55669 Issued in CA
Legal business name
KUNIMOTO DENTAL CORP
Practice address
4661 Precissi LN
Suite a
Stockton, CA 95207-6206
Phone
(209) 478-7221
NPI assigned
Feb 1, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2010

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

Authorized official

Name
Dr. Blake K Kunimoto, DDS
Title
President
Phone
(209) 478-7221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 55669 CA Primary

Addresses

Primary practice location

4661 Precissi LN
Suite a
Stockton, CA 95207-6206

Mailing address

4661 Precissi LN
Suite a
Stockton, CA 95207-6206
Phone (209) 478-7221

Other names 1

  • Brite Dental Group Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1264982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264982400000",
    "number": "1508198680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4661 PRECISSI LN",
            "address_2": "SUITE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076206",
            "telephone_number": "209-478-7221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4661 PRECISSI LN",
            "address_2": "SUITE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076206",
            "telephone_number": "209-478-7221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUNIMOTO DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-01",
        "last_updated": "2010-02-01",
        "status": "A",
        "authorized_official_last_name": "KUNIMOTO",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-478-7221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brite Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; 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.