Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35087884 | OH |
N | 208600000X | Surgeon | 35087884 | OH |
Y | 208200000X | Surgeon | D67979 | MD |
Y | 208600000X | Surgeon | D67979 | MD |
NPI | 1003923772 |
---|---|
Provider Name | Kenzo Hirose |
First Address | Baltimore, MD 21287-4563 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 07/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2662597 | (05) | OH |
415767200 | (05) | MD |
H79069 | (02) | OH |