Healthcare Provider Details

I. General information

NPI: 1699462184
Provider Name (Legal Business Name): HIDEYASU OUCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21810 NORMANDIE AVE
TORRANCE CA
90502-2047
US

IV. Provider business mailing address

3737 BRIARBROOKE LN
OAKLAND TOWNSHIP MI
48306-4736
US

V. Phone/Fax

Practice location:
  • Phone: 424-492-3300
  • Fax:
Mailing address:
  • Phone: 248-425-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA209039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: