Healthcare Provider Details

I. General information

NPI: 1003420399
Provider Name (Legal Business Name): KYLE KIYOSHI HARADA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19998 HOMESTEAD RD STE E
CUPERTINO CA
95014-0569
US

IV. Provider business mailing address

19998 HOMESTEAD RD STE E
CUPERTINO CA
95014-0569
US

V. Phone/Fax

Practice location:
  • Phone: 408-257-5262
  • Fax: 408-257-8271
Mailing address:
  • Phone: 408-257-5262
  • Fax: 408-257-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34666
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: