Provider Demographics
NPI:1699124131
Name:HARA, GARY KENTARO
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:KENTARO
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 1:501 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1615
Mailing Address - Country:US
Mailing Address - Phone:714-220-4040
Mailing Address - Fax:
Practice Address - Street 1:501 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1615
Practice Address - Country:US
Practice Address - Phone:714-220-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No172V00000XOther Service ProvidersCommunity Health Worker