Provider Demographics
NPI:1750552568
Name:ITO, SHIZUE HAYASHI (LAC)
Entity type:Individual
Prefix:
First Name:SHIZUE
Middle Name:HAYASHI
Last Name:ITO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 HARBOR BLVD.,
Mailing Address - Street 2:SUITES A & B
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:949-648-2788
Mailing Address - Fax:949-726-1638
Practice Address - Street 1:2960 HABOR BLVD.,
Practice Address - Street 2:SUITE A & B
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:949-648-2788
Practice Address - Fax:949-726-1638
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7144171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist