Provider Demographics
NPI:1649580358
Name:KAGAWA, HIROMI
Entity Type:Individual
Prefix:
First Name:HIROMI
Middle Name:
Last Name:KAGAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20080 RODRIGUES AVE
Mailing Address - Street 2:APT C
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3144
Mailing Address - Country:US
Mailing Address - Phone:408-647-5439
Mailing Address - Fax:732-753-4614
Practice Address - Street 1:830 STEWART DR
Practice Address - Street 2:#108
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085
Practice Address - Country:US
Practice Address - Phone:408-647-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13774171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist