Healthcare Provider Details

I. General information

NPI: 1316948458
Provider Name (Legal Business Name): DEAN KENJI TAKIGUCHI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6082 EDINGER AVE STE 100
HUNTINGTON BEACH CA
92647-3264
US

IV. Provider business mailing address

1 SPRINGFLOWER
IRVINE CA
92614-7588
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-0811
  • Fax: 714-546-3811
Mailing address:
  • Phone: 949-653-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: