Provider Demographics
NPI:1710138466
Name:GLENN T. HIFUMI, M.D.
Entity Type:Organization
Organization Name:GLENN T. HIFUMI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HIFUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-925-8892
Mailing Address - Street 1:9604 ARTESIA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-8039
Mailing Address - Country:US
Mailing Address - Phone:562-925-8892
Mailing Address - Fax:562-866-5978
Practice Address - Street 1:9604 ARTESIA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-8039
Practice Address - Country:US
Practice Address - Phone:562-925-8892
Practice Address - Fax:562-866-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68228208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty