Provider Demographics
NPI:1477584928
Name:TAKAHASHI, PATRICK HIDEO (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:HIDEO
Last Name:TAKAHASHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 680
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4810
Mailing Address - Country:US
Mailing Address - Phone:213-620-0822
Mailing Address - Fax:213-620-1384
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 680
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-620-0822
Practice Address - Fax:213-620-1384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054838207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54838Medicaid
CAA54838Medicaid
CAWA54838BMedicare PIN