Healthcare Provider Details

I. General information

NPI: 1609057918
Provider Name (Legal Business Name): HARO OGAWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 BASSWOOD DR
SAN RAMON CA
94582-3040
US

IV. Provider business mailing address

2550 SHATTUCK AVE
BERKELEY CA
94704-2724
US

V. Phone/Fax

Practice location:
  • Phone: 925-518-5143
  • Fax:
Mailing address:
  • Phone: 510-666-8234
  • Fax: 510-666-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: