Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | A68938 | CA |
NPI | 1457478646 |
---|---|
Provider Name | Shinjiro Hirose |
First Address | Sacramento, CA 95827-2539 |
Second Address | Sacramento, CA 95816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2015 |