Provider Demographics
NPI:1821331638
Name:TAKAYAMA, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TAKAYAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MOLLY CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6027
Mailing Address - Country:US
Mailing Address - Phone:916-202-3262
Mailing Address - Fax:
Practice Address - Street 1:501 DEREK PL STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-7053
Practice Address - Country:US
Practice Address - Phone:916-202-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26505174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator