MEDICARE: DR. KENT T. HIURA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DF033469	CA

General Provider Information

NPI Number	:	1487988895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT T. HIURA D.D.S.

Provider Business Mailing Address
First Line	:	595 N 1ST ST
Second Line	:	STE B
City	:	SAN JOSE
State	:	CA
Zip	:	95112-5326
Country	:	US
Telephone Number	:	408-279-2992
Fax Number	:	408-279-0203

Provider Business Practice Location Address
First Line	:	595 N 1ST ST
Second Line	:	STE B
City	:	SAN JOSE
State	:	CA
Zip	:	95112-5326
Country	:	US
Telephone Number	:	408-279-2992
Fax Number	:	408-279-0203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	10/01/2009

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