MEDICARE: DR. DARREN LEE TAKEUCHI M.D.

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	G77351	CA
2	208D00000X	General Practice Physician	G77351	CA
3	207P00000X	Emergency Medicine Physician	G77351	CA

General Provider Information

NPI Number	:	1982649141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARREN LEE TAKEUCHI M.D.

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8767 WILSHIRE BLVD FL 2
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2714
Country	:	US
Telephone Number	:	310-248-7000
Fax Number	:

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	01/06/2025

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