Provider Demographics
NPI:1871789776
Name:ITANO, ALAN S K (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:S K
Last Name:ITANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 N HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1808
Mailing Address - Country:US
Mailing Address - Phone:626-795-7698
Mailing Address - Fax:626-795-2116
Practice Address - Street 1:90 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1808
Practice Address - Country:US
Practice Address - Phone:626-795-7698
Practice Address - Fax:626-795-2116
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36944122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist