Healthcare Provider Details

I. General information

NPI: 1932316379
Provider Name (Legal Business Name): MS. AGNES HARUKO HIRAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

10596 KINNARD AVE
LOS ANGELES CA
90024-6039
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-5096
  • Fax: 323-226-7430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: