1366957995 NPI number — R HAYASHI DDS INC

Table of content: (NPI 1366957995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366957995 NPI number — R HAYASHI DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R HAYASHI DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RODEO DENTAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366957995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
448 IGNACIO BLVD UNIT 319
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94949-6085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-481-5949
Provider Business Mailing Address Fax Number:
877-739-4950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 RAILROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RODEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94572-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-455-7486
Provider Business Practice Location Address Fax Number:
877-739-4950
Provider Enumeration Date:
12/05/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEVEREUX
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
949-481-5949

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)