Healthcare Provider Details

I. General information

NPI: 1619048501
Provider Name (Legal Business Name): AKIRA KUGAYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24050 MADISON ST. SUITE 113
TORRANCE CA
90505-6016
US

IV. Provider business mailing address

24050 MADISON ST. SUITE 113
TORRANCE CA
90505-6016
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 Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA92092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: