Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 18938 | CA |
NPI | 1033210281 |
---|---|
Provider Name | Dr. Henry H Takei |
First Address | Los Angeles, CA 90017-3909 |
Second Address | Los Angeles, CA 90017-3909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |