Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2620 | NC |
N | 152W00000X | Optometrist | 34666 | CA |
NPI | 1003420399 |
---|---|
Provider Name | Dr. Kyle Kiyoshi Harada |
First Address | Durham, NC 27707-6281 |
Second Address | Durham, NC 27707-6281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 03/09/2020 |