Provider Demographics
NPI:1942452271
Name:HIROTA, SEAN KEN (MD)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:KEN
Last Name:HIROTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N. TUSTIN AVENUE
Mailing Address - Street 2:#705
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3611
Mailing Address - Country:US
Mailing Address - Phone:714-568-6600
Mailing Address - Fax:714-245-0260
Practice Address - Street 1:801 N. TUSTIN AVE.
Practice Address - Street 2:#705
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3611
Practice Address - Country:US
Practice Address - Phone:714-568-6600
Practice Address - Fax:714-245-0250
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111268207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095890Medicaid
W15717Medicare PIN
GD584CMedicare UPIN