Healthcare Provider Details

I. General information

NPI: 1942452271
Provider Name (Legal Business Name): SEAN KEN HIROTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N. TUSTIN AVE. #705
SANTA ANA CA
92705-3611
US

IV. Provider business mailing address

801 N. TUSTIN AVENUE #705
SANTA ANA CA
92705-3611
US

V. Phone/Fax

Practice location:
  • Phone: 714-568-6600
  • Fax: 714-245-0250
Mailing address:
  • Phone: 714-568-6600
  • Fax: 714-245-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA111268
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA111268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: