Provider Demographics
NPI:1740398023
Name:ITAGAKI, BRIAN HIRO (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HIRO
Last Name:ITAGAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:H
Other - Last Name:ITAGAKI M.D. INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2200 W 3RD ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1932
Mailing Address - Country:US
Mailing Address - Phone:213-484-7600
Mailing Address - Fax:213-484-7566
Practice Address - Street 1:2200 W 3RD ST
Practice Address - Street 2:SUITE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1932
Practice Address - Country:US
Practice Address - Phone:213-484-7600
Practice Address - Fax:213-484-7566
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37936207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710023718OtherAETNA
CA1740398023OtherBLUE CROSS
CA1710023718OtherBLUE SHIELD
CA1710023718OtherMEDICARE W2
CA1710023718Medicaid
CA1710023718OtherMEDICARE W2
CAG37936Medicare ID - Type Unspecified
A47293Medicare UPIN