1043032642 NPI number — HIROSHI DATE MD

Table of content: HIROSHI DATE MD (NPI 1043032642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043032642 NPI number — HIROSHI DATE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DATE
Provider First Name:
HIROSHI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1043032642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HIGASHIDA-CHO, JODOJI, SAKYO-KU
Provider Second Line Business Mailing Address:
DE'LEAD TETSUGAKUNOMICHI 507
Provider Business Mailing Address City Name:
KYOTO
Provider Business Mailing Address State Name:
KYOTO
Provider Business Mailing Address Postal Code:
6068411
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 DUKE MEDICINE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-613-5635
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  PENDING , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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