Healthcare Provider Details

I. General information

NPI: 1366463812
Provider Name (Legal Business Name): ROGER M HAYASHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 SAMARITAN CT STE E
SAN JOSE CA
95124-4002
US

IV. Provider business mailing address

2512 SAMARITAN CT STE E
SAN JOSE CA
95124-4002
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-8272
  • Fax: 408-356-7779
Mailing address:
  • Phone: 408-358-8272
  • Fax: 408-356-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG32902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: