Provider Demographics
NPI:1265593602
Name:TAKEUCHI, JASON (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:TAKEUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 N SAN MATEO DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2622
Mailing Address - Country:US
Mailing Address - Phone:650-348-4900
Mailing Address - Fax:650-357-1067
Practice Address - Street 1:215 N SAN MATEO DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2622
Practice Address - Country:US
Practice Address - Phone:650-348-4900
Practice Address - Fax:650-357-1067
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA552402084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry