Provider Demographics
NPI:1235602228
Name:TAKEDA, HIROKI
Entity Type:Individual
Prefix:
First Name:HIROKI
Middle Name:
Last Name:TAKEDA
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 1:2306 CALLE DE RAFAEL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1037
Mailing Address - Country:US
Mailing Address - Phone:505-423-4139
Mailing Address - Fax:
Practice Address - Street 1:2306 CALLE DE RAFAEL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1037
Practice Address - Country:US
Practice Address - Phone:505-423-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM979171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist