Healthcare Provider Details

I. General information

NPI: 1295797397
Provider Name (Legal Business Name): EDWIN S. HAYASHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 OAK PARK BLVD STE 201
PISMO BEACH CA
93449-3400
US

IV. Provider business mailing address

77 CASA ST SUITE 103
SAN LUIS OBISPO CA
93405-5803
US

V. Phone/Fax

Practice location:
  • Phone: 805-546-0411
  • Fax: 805-473-4891
Mailing address:
  • Phone: 805-546-0411
  • Fax: 805-489-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG74276
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG74276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: