Provider Demographics
NPI:1457478646
Name:HIROSE, SHINJIRO (MD)
Entity Type:Individual
Prefix:
First Name:SHINJIRO
Middle Name:
Last Name:HIROSE
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 1:2335 STOCKTON BLVD
Mailing Address - Street 2:NORTH ADDITION OFFICE BUILDING, 6TH FLOOR
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1418
Mailing Address - Country:US
Mailing Address - Phone:916-453-2080
Mailing Address - Fax:916-453-2035
Practice Address - Street 1:SHRINER'S HOSPITAL
Practice Address - Street 2:2425 STOCKTON BOULEVARD, SUITE 517
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2215
Practice Address - Country:US
Practice Address - Phone:916-453-2000
Practice Address - Fax:415-476-2314
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA689382086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery