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General NPI Number Information
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NPI Number | 1265627731
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Entity Type | Organization
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Legal Business Name | MIKIO TACHIBANA, M.D., INC
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 11100 WARNER AVE SUITE 154
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7506
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Country | US
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Telephone | 714-966-2800
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Fax | 714-966-0421
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Provider Business Mailing Address
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Address Line | 11100 WARNER AVE SUITE 154
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7506
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Country | US
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Telephone | 714-966-2800
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Fax | 714-966-0421
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKIO TACHIBANA
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Credential | M.D.
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Telephone | 714-966-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A35433
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License Number State | CA
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