Provider Demographics
NPI:1083783435
Name:TAKAKI, KATHERINE K (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:K
Last Name:TAKAKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16835 ALGONQUIN ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3810
Mailing Address - Country:US
Mailing Address - Phone:818-640-6209
Mailing Address - Fax:
Practice Address - Street 1:5460 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2023
Practice Address - Country:US
Practice Address - Phone:714-463-7500
Practice Address - Fax:714-992-7850
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9350152W00000X
CA9350T152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU09473Medicare UPIN
CACH710ZMedicare PIN
CAU09473Medicare UPIN
CAWY4301Medicare ID - Type UnspecifiedGROUP #
CACH710ZMedicare PIN