Healthcare Provider Details

I. General information

NPI: 1215025275
Provider Name (Legal Business Name): LAUREN SHIN HIYAMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

IV. Provider business mailing address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-4500
  • Fax: 559-261-1526
Mailing address:
  • Phone: 559-436-4500
  • Fax: 559-261-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA84500
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA84500
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA84500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: