Provider Demographics
NPI:1659638369
Name:KOYAMA, HIRONARI (DC)
Entity Type:Individual
Prefix:DR
First Name:HIRONARI
Middle Name:
Last Name:KOYAMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TAESUNG
Other - Middle Name:
Other - Last Name:BYUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:24828 OAK ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1622
Mailing Address - Country:US
Mailing Address - Phone:310-691-4172
Mailing Address - Fax:
Practice Address - Street 1:12629 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2303
Practice Address - Country:US
Practice Address - Phone:310-391-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor