MEDICARE: RANDALL T HAYASHI DDS INC

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	122300000X	Dentist	36765	CA

General Provider Information

NPI Number	:	1548692205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL T HAYASHI DDS INC

Provider Business Mailing Address
First Line	:	1036 W ROBINHOOD
Second Line	:	SUITE 104
City	:	STOCKTON
State	:	CA
Zip	:	95207-5622
Country	:	US
Telephone Number	:	209-956-9650
Fax Number	:	209-956-9655

Provider Business Practice Location Address
First Line	:	1036 W ROBINHOOD DR
Second Line	:	SUITE 104
City	:	STOCKTON
State	:	CA
Zip	:	95207-5623
Country	:	US
Telephone Number	:	209-956-9650
Fax Number	:	209-956-9655

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANDALL T HAYASHI
Credential	:	DDS
Telephone Number	:	209-604-5666

Provider Enumeration Date	:	08/05/2013
Last Update Date	:	08/05/2013

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