Basic Information
| Provider Information | |||||||||
| NPI: | 1528272366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'CONNOR | ||||||||
| FirstName: | KYOMI | ||||||||
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| Credential: | DMD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3586 TORREY VIEW CT | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921302635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582594757 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50100 GOLSH RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CENTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920825338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607491410 | ||||||||
| FaxNumber: | 7607494239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 45943 | CA | Y | Dental Providers | Dentist | Pediatric Dentistry | 1223P0221X | 5900 | DC | N | Dental Providers | Dentist | Pediatric Dentistry | 1223P0221X | 12357 | MD | N | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.