Healthcare Provider Details

I. General information

NPI: 1598077851
Provider Name (Legal Business Name): MARC HAYASHI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PLAZA DRIVEWAY SUITE #350
LOS ANGELES CA
90095-2820
US

IV. Provider business mailing address

10833 LE CONTE AVE CHS 33-019
LOS ANGELES CA
90095-1668
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-5750
  • Fax: 310-825-2951
Mailing address:
  • Phone: 310-825-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60054
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE 60128317
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: