Healthcare Provider Details

I. General information

NPI: 1891822763
Provider Name (Legal Business Name): SHINO HIRAI LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 S ORCAS ST
SEATTLE WA
98108-2929
US

IV. Provider business mailing address

2007 S ORCAS ST
SEATTLE WA
98108-2929
US

V. Phone/Fax

Practice location:
  • Phone: 206-767-9525
  • Fax:
Mailing address:
  • Phone: 206-767-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00021718
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: