Healthcare Provider Details

I. General information

NPI: 1861697450
Provider Name (Legal Business Name): JOHN ICHIRO TAKAYAMA M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSF MEDICAL CENTER CHILDRENS HOSPITAL 400 PARNASSUS AVE 2ND FLOOR
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

UCSF MEDICAL CENTER CHILDRENS HOSPITAL 400 PARNASSUS AVE 2ND FLOOR
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2211
  • Fax:
Mailing address:
  • Phone: 415-353-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG67205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: