MEDICARE: DR. SCOTT MUSASHI HIROSE DDS

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	110107	CA

General Provider Information

NPI Number	:	1679314462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT MUSASHI HIROSE DDS

Provider Business Mailing Address
First Line	:	10453 SCENIC CT
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-2765
Country	:	US
Telephone Number	:	408-605-0514
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 14TH ST LOWR LEVEL01
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-4059
Country	:	US
Telephone Number	:	510-451-6828
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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