Individual
KYLE HIROMI HATANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
9450 #120 FAIRVIEW AVENUE, BOISE, ID 83704
(530) 515-1064
Mailing address
5112 NE 47TH PL, PORTLAND, OR 97218-2066
(530) 515-1064
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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