Provider Demographics
NPI:1972537520
Name:HIRAYAMA, MEGUMI (DOM)
Entity type:Individual
Prefix:DR
First Name:MEGUMI
Middle Name:
Last Name:HIRAYAMA
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6756
Mailing Address - Country:US
Mailing Address - Phone:505-888-6888
Mailing Address - Fax:505-883-9088
Practice Address - Street 1:4135 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6756
Practice Address - Country:US
Practice Address - Phone:505-888-6888
Practice Address - Fax:505-883-9088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM517RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist