Provider Demographics
NPI:1669135158
Name:HIROSE, JO ANN SALLY
Entity type:Individual
Prefix:
First Name:JO ANN
Middle Name:SALLY
Last Name:HIROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2146 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2109
Mailing Address - Country:US
Mailing Address - Phone:323-804-1782
Mailing Address - Fax:
Practice Address - Street 1:316 E 2ND ST STE 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4223
Practice Address - Country:US
Practice Address - Phone:213-680-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist