Provider Demographics
NPI:1609057918
Name:OGAWA, HARO
Entity Type:Individual
Prefix:
First Name:HARO
Middle Name:
Last Name:OGAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2724
Mailing Address - Country:US
Mailing Address - Phone:510-666-8234
Mailing Address - Fax:510-666-0111
Practice Address - Street 1:2617 BASSWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-3040
Practice Address - Country:US
Practice Address - Phone:925-518-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11771171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist