Provider Demographics
NPI:1578827226
Name:TAKAI, JEFF (DDS)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:TAKAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 PRESIDIO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2921
Mailing Address - Country:US
Mailing Address - Phone:949-244-6481
Mailing Address - Fax:
Practice Address - Street 1:882 PRESIDIO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2921
Practice Address - Country:US
Practice Address - Phone:949-244-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59877OtherDENTAL BOARD OF CALIFORNIA