Basic Information
| Provider Information | |||||||||
| NPI: | 1962405290 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAYASHI | ||||||||
| FirstName: | GRANT | ||||||||
| MiddleName: | MASASHI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 STARDUST ST | ||||||||
| Address2: | STE D | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757463400 | ||||||||
| FaxNumber: | 7757463411 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 STARDUST ST | ||||||||
| Address2: | STE D | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757463400 | ||||||||
| FaxNumber: | 7757463411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 9368 | NV | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | A55802 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | XPY068120 | 01 | NV | MEDICAL | OTHER |