Provider Demographics
NPI:1982763389
Name:HASHIMOTO, KEVIN T (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:HASHIMOTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22809 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3615
Mailing Address - Country:US
Mailing Address - Phone:310-373-5055
Mailing Address - Fax:
Practice Address - Street 1:22809 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3615
Practice Address - Country:US
Practice Address - Phone:310-373-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11059 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0110590Medicaid
CASD0110592Medicaid
CASD0110591Medicaid
CASD0110593Medicaid
CAWOP11059DMedicare PIN
CAWOP11059AMedicare PIN
CASD0110590Medicaid
CAWOP11059CMedicare PIN
CAWOP11059BMedicare PIN