Provider Demographics
NPI:1417175829
Name:HIRASAKI, KEN KIYOSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:KIYOSHI
Last Name:HIRASAKI
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-416-1360
Mailing Address - Fax:
Practice Address - Street 1:11600 WEST 2ND PLACE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228
Practice Address - Country:US
Practice Address - Phone:720-321-0000
Practice Address - Fax:720-321-1621
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004000442085R0202X
OR282552085R0202X
CODR.00557062085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR242525Medicaid
ORR141515Medicare PIN