Provider Demographics
NPI:1578542569
Name:ABE, JOHN TAKEO (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TAKEO
Last Name:ABE
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 1:3701 SKYPARK DR
Mailing Address - Street 2:# 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4749
Mailing Address - Country:US
Mailing Address - Phone:310-378-8900
Mailing Address - Fax:310-791-0786
Practice Address - Street 1:3701 SKYPARK DR
Practice Address - Street 2:# 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4749
Practice Address - Country:US
Practice Address - Phone:310-378-8900
Practice Address - Fax:310-791-0786
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153919207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578542569Medicaid
CA00G760411Medicaid
CAGX075YMedicare PIN
CA00G760411Medicaid
CAGX075ZMedicare PIN
WG76041BMedicare ID - Type Unspecified