Healthcare Provider Details

I. General information

NPI: 1497764641
Provider Name (Legal Business Name): KENNETH HIROSHI HAYASHIDA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25982 PALA SUITE 100
MISSION VIEJO CA
92691-6719
US

IV. Provider business mailing address

25982 PALA SUITE 100
MISSION VIEJO CA
92691-6719
US

V. Phone/Fax

Practice location:
  • Phone: 949-916-5437
  • Fax: 949-215-3623
Mailing address:
  • Phone: 949-916-5437
  • Fax: 949-215-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA056162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: