Provider Demographics
NPI:1285166736
Name:HARA, SIMON KIYOSHI
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:KIYOSHI
Last Name:HARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2529
Mailing Address - Country:US
Mailing Address - Phone:510-220-0510
Mailing Address - Fax:
Practice Address - Street 1:1330 LINCOLN AVE.
Practice Address - Street 2:#201 COMMUNITY INSTITUTE FOR PSYCHOTHERAPY
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:99401-2141
Practice Address - Country:US
Practice Address - Phone:415-459-5999
Practice Address - Fax:415-459-5602
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program