Provider Demographics
NPI:1750325130
Name:MIYASAKI, SHELLEY HIROKO (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:HIROKO
Last Name:MIYASAKI
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 CLEMENT ST
Mailing Address - Street 2:DENTAL SERVICE (160)
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1545
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-750-6603
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:DENTAL SERVICE MAIL STOP #160
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-750-6603
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery