MEDICARE: DR. BRIAN HIRO ITAGAKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	G37936	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	1710023718	OTHER	CA	MEDICARE W2

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1710023718	OTHER	CA	AETNA
2	1740398023	OTHER	CA	BLUE CROSS
3	1710023718	OTHER	CA	BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740398023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN HIRO ITAGAKI MD

Provider Business Mailing Address
First Line	:	2200 W 3RD ST
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1932
Country	:	US
Telephone Number	:	213-484-7600
Fax Number	:	213-484-7566

Provider Business Practice Location Address
First Line	:	2200 W 3RD ST
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1932
Country	:	US
Telephone Number	:	213-484-7600
Fax Number	:	213-484-7566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	11/11/2015

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Directions to “ DR. BRIAN HIRO ITAGAKI MD” Practice Location

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