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General NPI Number Information
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NPI Number | 1316404007
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Entity Type | Individual
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Provider Name | ANNIE TAK
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Gender | Female
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 4 HUGHES STE 150
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City | IRVINE
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State | CA
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Zip | 92618-2044
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Country | US
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Telephone | 949-768-6780
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Fax |
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Provider Business Mailing Address
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Address Line | 124 MESSENGER
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City | IRVINE
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State | CA
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Zip | 92618-1335
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Country | US
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Telephone | 949-351-3795
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95011267
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License Number State | CA
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