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General NPI Number Information
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NPI Number | 1083872196
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Entity Type | Individual
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Provider Name | MARC DAVID IKEDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2008
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 6600 BRUCEVILLE RD MOB 3 - SUITE 233
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City | SACRAMENTO
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State | CA
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Zip | 95823-4671
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Country | US
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Telephone | 916-627-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 BRUCEVILLE RD MOB 3 - SUITE 233
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City | SACRAMENTO
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State | CA
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Zip | 95823-4671
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A105562
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | MT200406
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | A105562
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License Number State | CA
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