Provider Demographics
NPI:1417148776
Name:HAMASAKI, KEVIN MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MITCHELL
Last Name:HAMASAKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3642 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5726
Mailing Address - Country:US
Mailing Address - Phone:213-272-0797
Mailing Address - Fax:
Practice Address - Street 1:3642 WEST BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5726
Practice Address - Country:US
Practice Address - Phone:213-272-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18101111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18101Medicare PIN