Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP20600 | CA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | NP20600 | CA |
NPI | 1235473976 |
---|---|
Provider Name | Grace Chang Takahashi |
First Address | Los Angeles, CA 90095-8358 |
Second Address | Los Angeles, CA 90095-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2012 |
Last Update Date | 22/11/2021 |