Healthcare Provider Details

I. General information

NPI: 1720290752
Provider Name (Legal Business Name): TAKAKO MITSUHASHI M.D.,PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 CAMPUS DR
IRVINE CA
92612-1601
US

IV. Provider business mailing address

2601 CAMPUS DR
IRVINE CA
92612-1601
US

V. Phone/Fax

Practice location:
  • Phone: 949-265-1782
  • Fax: 949-754-9330
Mailing address:
  • Phone: 949-265-1782
  • Fax: 949-754-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA69535
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA69535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: