Healthcare Provider Details

I. General information

NPI: 1922151638
Provider Name (Legal Business Name): ROY MASATO HAYASHI D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27462 PORTOLA PKWY SUITE 200
FOOTHILL RANCH CA
92610-2815
US

IV. Provider business mailing address

27462 PORTOLA PKWY SUITE 200
FOOTHILL RANCH CA
92610-2815
US

V. Phone/Fax

Practice location:
  • Phone: 949-273-8575
  • Fax: 949-273-8577
Mailing address:
  • Phone: 949-273-8575
  • Fax: 949-273-8577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number53528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: