Provider Demographics
NPI:1548692205
Name:RANDALL T HAYASHI DDS INC
Entity type:Organization
Organization Name:RANDALL T HAYASHI DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-604-5666
Mailing Address - Street 1:1036 W ROBINHOOD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5622
Mailing Address - Country:US
Mailing Address - Phone:209-956-9650
Mailing Address - Fax:209-956-9655
Practice Address - Street 1:1036 W ROBINHOOD DR
Practice Address - Street 2:SUITE 104
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5623
Practice Address - Country:US
Practice Address - Phone:209-956-9650
Practice Address - Fax:209-956-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty