Healthcare Provider Details

I. General information

NPI: 1467742288
Provider Name (Legal Business Name): TRANSHOPE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24050 MADISON ST SUITE 113
TORRANCE CA
90505-6015
US

IV. Provider business mailing address

24050 MADISON ST SUITE 113
TORRANCE CA
90505-6015
US

V. Phone/Fax

Practice location:
  • Phone: 424-247-9642
  • Fax: 424-247-9643
Mailing address:
  • Phone: 424-247-9642
  • Fax: 424-247-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA92092
License Number StateCA

VIII. Authorized Official

Name: AKIRA KUGAYA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 424-247-9642