Basic Information
| Provider Information | |||||||||
| NPI: | 1457478646 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HIROSE | ||||||||
| FirstName: | SHINJIRO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2335 STOCKTON BLVD | ||||||||
| Address2: | NORTH ADDITION OFFICE BUILDING, 6TH FLOOR | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164532080 | ||||||||
| FaxNumber: | 9164532035 | ||||||||
| Practice Location | |||||||||
| Address1: | SHRINER'S HOSPITAL | ||||||||
| Address2: | 2425 STOCKTON BOULEVARD, SUITE 517 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164532000 | ||||||||
| FaxNumber: | 4154762314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | A68938 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
No ID Information.