Provider Demographics
NPI:1184700601
Name:AKUTAGAWA, DENNIS R (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:AKUTAGAWA
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 1:211 MARTINVALE LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1838
Mailing Address - Country:US
Mailing Address - Phone:408-629-3969
Mailing Address - Fax:
Practice Address - Street 1:211 MARTINVALE LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1838
Practice Address - Country:US
Practice Address - Phone:408-629-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G384270Medicaid
00G384270Medicare ID - Type Unspecified
CA00G384270Medicaid