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General NPI Number Information
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NPI Number | 1710023718
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Entity Type | Organization
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Legal Business Name | BRIAN H. ITAGAKI M.D., INC.
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 2200 W 3RD ST SUITE 120A
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City | LOS ANGELES
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State | CA
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Zip | 90057-1932
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Country | US
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Telephone | 213-484-7303
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Fax | 213-484-7399
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Provider Business Mailing Address
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Address Line | 2200 W 3RD ST 120A
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City | LOS ANGELES
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State | CA
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Zip | 90057-1932
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Country | US
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Telephone | 213-484-7303
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Fax | 213-484-7399
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN HIRO ITAGAKI
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Credential | M.D.
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Telephone | 213-484-7303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G37936
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License Number State | CA
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