Provider Demographics
NPI:1649788696
Name:SHIRLEY S. HIRAYAMA DDS
Entity type:Organization
Organization Name:SHIRLEY S. HIRAYAMA DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HIRAYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-593-7171
Mailing Address - Street 1:2117 FOOTHILL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2902
Mailing Address - Country:US
Mailing Address - Phone:909-593-7171
Mailing Address - Fax:909-593-7603
Practice Address - Street 1:2117 FOOTHILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2902
Practice Address - Country:US
Practice Address - Phone:909-593-7171
Practice Address - Fax:909-593-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32093261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental