MEDICARE: GRACE CHANG TAKAHASHI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	20600	CA

General Provider Information

NPI Number	:	1235473976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE CHANG TAKAHASHI NP

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-8358
Country	:	US
Telephone Number	:	310-301-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 WESTWOOD PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1324
Country	:	US
Telephone Number	:	310-825-6301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	10/01/2025

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