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General NPI Number Information
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NPI Number | 1215563283
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Entity Type | Individual
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Provider Name | CORY KISHI HIRO MAYFIELD MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 2051 MARENGO ST STE A7D
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City | LOS ANGELES
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State | CA
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Zip | 90033-1352
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Country | US
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Telephone | 310-591-6735
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735263
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City | CHICAGO
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State | IL
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Zip | 60673-5263
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Country | US
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Telephone |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036.178366
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A179921
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 036.178366
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License Number State | IL
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