Provider Demographics
NPI:1396871919
Name:AKIMOTO, VINCENT TAIJERON (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:TAIJERON
Last Name:AKIMOTO
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 1:1244 NORTH MARINE CORPS DRIVE
Mailing Address - Street 2:
Mailing Address - City:UPPER TUMON
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-647-8262
Mailing Address - Fax:671-647-8257
Practice Address - Street 1:1244 NORTH MARINE CORPS DRIVE
Practice Address - Street 2:AMERICAN MEDICAL CENTER
Practice Address - City:UPPER TUMON
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-8262
Practice Address - Fax:671-647-8257
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G19201Medicare UPIN
100639Medicare ID - Type Unspecified