Healthcare Provider Details

I. General information

NPI: 1770923849
Provider Name (Legal Business Name): HIROFUMI KURODA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 AUSTIN RD
STOCKTON CA
95215
US

IV. Provider business mailing address

PO BOX 6510
ALAMEDA CA
94501-7610
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: