Provider Demographics
NPI:1407895477
Name:TAKASHIMA, MASAYOSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:MASAYOSHI
Middle Name:
Last Name:TAKASHIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST STE 1723
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2747
Mailing Address - Country:US
Mailing Address - Phone:713-441-1368
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST STE 1723
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2747
Practice Address - Country:US
Practice Address - Phone:713-441-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2143207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179469508Medicaid
TX8D9056Medicare PIN
TX8G5604Medicare PIN