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General NPI Number Information
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NPI Number | 1053960286
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Entity Type | Individual
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Provider Name | KYLE HIROMI HATANAKA LAC
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Gender | Male
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 9450 #120 FAIRVIEW AVENUE
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 530-515-1064
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Fax |
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Provider Business Mailing Address
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Address Line | 5112 NE 47TH PL
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City | PORTLAND
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State | OR
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Zip | 97218-2066
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Country | US
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Telephone | 530-515-1064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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