Provider Demographics
NPI:1124025960
Name:HIRANO, PAUL S
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:HIRANO
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 1:2130 REDONDO BEACH BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1680
Mailing Address - Country:US
Mailing Address - Phone:310-538-9797
Mailing Address - Fax:310-538-1725
Practice Address - Street 1:2130 REDONDO BEACH BLVD STE G
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1680
Practice Address - Country:US
Practice Address - Phone:310-538-9797
Practice Address - Fax:310-538-1725
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00007487T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0074870Medicaid
CAU64077Medicare UPIN
4293370001Medicare NSC