Healthcare Provider Details

I. General information

NPI: 1487721189
Provider Name (Legal Business Name): MARK H TAKEMURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20911 EARL STREET SUITE 280
TORRANCE CA
90503
US

IV. Provider business mailing address

20911 EARL STREET SUITE 280
TORRANCE CA
90503
US

V. Phone/Fax

Practice location:
  • Phone: 310-214-7236
  • Fax: 310-542-0334
Mailing address:
  • Phone: 310-214-7236
  • Fax: 310-542-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG58448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: