Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | F5610 | CA |
NPI | 1457679656 |
---|---|
Provider Name | Dr. Hirohito Ichii |
First Address | Los Angeles, CA 90051-0347 |
Second Address | Orange, CA 92868-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2010 |
Last Update Date | 13/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F5610 | 2113 CERTIFICATE OF REGISTRATION (01) | CA |