Provider Demographics
NPI:1831311745
Name:TAKAHASHI, DENISE (PHARMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:TAKAHASHI
Suffix:
Gender:F
Credentials:PHARMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W VICTORY BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1256
Mailing Address - Country:US
Mailing Address - Phone:818-209-8574
Mailing Address - Fax:
Practice Address - Street 1:2300 W VICTORY BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1256
Practice Address - Country:US
Practice Address - Phone:818-209-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist