MEDICARE: DR. STEPHEN M HIROSHIGE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	40246	CA

General Provider Information

NPI Number	:	1346459237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN M HIROSHIGE D.D.S.

Provider Business Mailing Address
First Line	:	9802 GARRETT CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-3638
Country	:	US
Telephone Number	:	714-964-5164
Fax Number	:	310-323-4383

Provider Business Practice Location Address
First Line	:	1600 W REDONDO BEACH BLVD
Second Line	:	SUITE #306
City	:	GARDENA
State	:	CA
Zip	:	90247-3226
Country	:	US
Telephone Number	:	310-323-2842
Fax Number	:	310-323-4383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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