Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 046142 | NY |
NPI | 1154456556 |
---|---|
Provider Name | Mr. Hiroshi Kimura |
First Address | New York, NY 10019 |
Second Address | New York, NY 10019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |