Healthcare Provider Details

I. General information

NPI: 1679101380
Provider Name (Legal Business Name): HIROE IMAI HU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW STE 200
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

1050 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-5304
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5400
  • Fax:
Mailing address:
  • Phone: 201-809-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO210001349
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: