Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | N0117 | TX |
Y | 2080P0208X | Pediatric Infectious Diseases | N0117 | TX |
NPI | 1326203266 |
---|---|
Provider Name | Dr. Takehisa Ikeda |
First Address | Pearland, TX 77588-3278 |
Second Address | Houston, TX 77043-2742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 11/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205456101 | (05) | TX |