Healthcare Provider Details

I. General information

NPI: 1659678654
Provider Name (Legal Business Name): SAMUEL TOKUYAMA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 BROWN DR
BURBANK CA
91504-1838
US

IV. Provider business mailing address

855 BROWN DR
BURBANK CA
91504-1838
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-1945
  • Fax:
Mailing address:
  • Phone: 818-848-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2OA4269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: