Provider Demographics
NPI:1487117875
Name:TAMASHIRO, CHASE MASAO
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:MASAO
Last Name:TAMASHIRO
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 1:9100 WILSHIRE BLVD STE 280E
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3562
Mailing Address - Country:US
Mailing Address - Phone:310-652-3668
Mailing Address - Fax:
Practice Address - Street 1:9100 WILSHIRE BLVD STE 280E
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3562
Practice Address - Country:US
Practice Address - Phone:310-652-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAE5861213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program