Provider Demographics
NPI:1609856939
Name:ISHIHARA, TERRY (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:ISHIHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5400 W ROSECRANS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6609
Mailing Address - Country:US
Mailing Address - Phone:310-643-8500
Mailing Address - Fax:310-297-7863
Practice Address - Street 1:5400 W ROSECRANS AVE
Practice Address - Street 2:STE 100
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6609
Practice Address - Country:US
Practice Address - Phone:310-643-8500
Practice Address - Fax:310-297-7863
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG87861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine