Healthcare Provider Details

I. General information

NPI: 1538276746
Provider Name (Legal Business Name): TSUNEO HIRABAYASHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23000 CRENSHAW BLVD #204
TORRANCE CA
90505-3052
US

IV. Provider business mailing address

23000 CRENSHAW BLVD #204
TORRANCE CA
90505-3052
US

V. Phone/Fax

Practice location:
  • Phone: 310-326-5661
  • Fax: 310-326-0347
Mailing address:
  • Phone: 310-326-5661
  • Fax: 310-326-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA025065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: