Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 63744 | CA |
NPI | 1063809804 |
---|---|
Provider Name | Dr. Shannon Miyuki Hayashibara |
First Address | Livermore, CA 94551-8872 |
Second Address | Livermore, CA 94551-8872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 20/04/2015 |