Provider Demographics
NPI:1073180170
Name:SHINAGAWA, GRANT MANABU HANJIN
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:MANABU HANJIN
Last Name:SHINAGAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S COUNTRY CLUB DR APT 1052
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3548
Mailing Address - Country:US
Mailing Address - Phone:607-280-8654
Mailing Address - Fax:
Practice Address - Street 1:901 S COUNTRY CLUB DR APT 1052
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3548
Practice Address - Country:US
Practice Address - Phone:607-280-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program