Individual
JOHN S KISHIBAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2601 OCEAN PARK BLVD, 304, SANTA MONICA, CA 90405-5210
(310) 581-5757
(310) 581-5759
Mailing address
2601 OCEAN PARK BLVD, 304, SANTA MONICA, CA 90405-5210
(310) 581-5757
(310) 581-5759
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
27778
CA
Other
Enumeration date
10/02/2006
Last updated
12/04/2012
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