Provider Demographics
NPI:1932542594
Name:TANABE, SACHIKO
Entity Type:Individual
Prefix:MS
First Name:SACHIKO
Middle Name:
Last Name:TANABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S CATALINA AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3300
Mailing Address - Country:US
Mailing Address - Phone:310-951-0241
Mailing Address - Fax:
Practice Address - Street 1:316 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4222
Practice Address - Country:US
Practice Address - Phone:213-680-0355
Practice Address - Fax:213-680-0830
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-14
Last Update Date:2013-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22902208D00000X
CA505502208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice