Provider Demographics
NPI:1164577151
Name:HARA, KAY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:S
Last Name:HARA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MARCH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2511
Mailing Address - Country:US
Mailing Address - Phone:805-525-5415
Mailing Address - Fax:805-525-0448
Practice Address - Street 1:255 MARCH ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2511
Practice Address - Country:US
Practice Address - Phone:805-525-5415
Practice Address - Fax:805-525-0448
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1383213E00000X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E13830OtherBLUE SHIELD
CA000E13830Medicaid
CA000E13830Medicaid
CAT10926Medicare UPIN