Provider Demographics
NPI:1295797397
Name:HAYASHI, EDWIN S (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:S
Last Name:HAYASHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:77 CASA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5803
Mailing Address - Country:US
Mailing Address - Phone:805-546-0411
Mailing Address - Fax:805-489-1421
Practice Address - Street 1:921 OAK PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3400
Practice Address - Country:US
Practice Address - Phone:805-546-0411
Practice Address - Fax:805-473-4891
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG742762086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G742760Medicaid
CA020033837Medicare PIN
CAG36756Medicare UPIN
CA00G742760Medicaid