Healthcare Provider Details

I. General information

NPI: 1649411091
Provider Name (Legal Business Name): HIROYUKI TERAKAWA LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 S BEVERLY DR SUITE 9
BEVERLY HILLS CA
90212-4427
US

IV. Provider business mailing address

441 S BEVERLY DR SUITE 9
BEVERLY HILLS CA
90212-4427
US

V. Phone/Fax

Practice location:
  • Phone: 310-415-6022
  • Fax:
Mailing address:
  • Phone: 310-415-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: