Provider Demographics
NPI:1972580074
Name:HIRAI, STANFORD K
Entity type:Individual
Prefix:
First Name:STANFORD
Middle Name:K
Last Name:HIRAI
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 1:9844 S 1300 E
Mailing Address - Street 2:STE 300
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4693
Mailing Address - Country:US
Mailing Address - Phone:801-572-0690
Mailing Address - Fax:
Practice Address - Street 1:9844 S 1300 E
Practice Address - Street 2:STE 150
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4687
Practice Address - Country:US
Practice Address - Phone:801-572-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120855-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR60803Medicare UPIN