Provider Demographics
NPI:1821011206
Name:TAKAMIYA, ROBERT K (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:TAKAMIYA
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:PO BOX 749730
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9730
Mailing Address - Country:US
Mailing Address - Phone:206-971-0034
Mailing Address - Fax:206-215-4351
Practice Address - Street 1:21605 76TH AVENUE W
Practice Address - Street 2:C/O SWEDISH CANCER INSTITUTE @ STEVENS
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-640-4300
Practice Address - Fax:425-640-4440
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000441582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8419988Medicaid
WAI19896Medicare UPIN
WA8419988Medicaid
WA8808515Medicare PIN