Provider Demographics
NPI:1215025275
Name:HIYAMA, LAUREN SHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:SHIN
Last Name:HIYAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7471 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2457
Mailing Address - Country:US
Mailing Address - Phone:559-436-4500
Mailing Address - Fax:559-261-1526
Practice Address - Street 1:7471 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2457
Practice Address - Country:US
Practice Address - Phone:559-436-4500
Practice Address - Fax:559-261-1526
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84500207K00000X, 207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21572ZOtherMEDICARE PTAN FOR ALL OFFICE LOCATIONS UNDER BAZ ALLERGY, ASTHMA & SINUS CENTER
CAGR0043790Medicaid