Provider Demographics
NPI:1982473567
Name:HANAMI, TIMOTHY MAMORU
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MAMORU
Last Name:HANAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 RONDA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-3734
Mailing Address - Country:US
Mailing Address - Phone:213-985-8030
Mailing Address - Fax:
Practice Address - Street 1:2011 RONDA DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-3734
Practice Address - Country:US
Practice Address - Phone:213-985-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty