Healthcare Provider Details

I. General information

NPI: 1477514495
Provider Name (Legal Business Name): DEAN T NORITAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 101
PASADENA CA
91105-2536
US

IV. Provider business mailing address

301 S FAIR OAKS AVE STE 101
PASADENA CA
91105-2536
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-2910
  • Fax: 626-296-2920
Mailing address:
  • Phone: 626-296-2910
  • Fax: 626-296-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG49215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: