MEDICARE: DR. TAKAKO MUKAI MD

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	390200000X	Student in an Organized Health Care Education/Training Program	B7897235	CA

General Provider Information

NPI Number	:	1366602427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAKAKO MUKAI MD

Provider Business Mailing Address
First Line	:	21263 ERWIN STREET
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367
Country	:	US
Telephone Number	:	818-592-3056
Fax Number	:	818-592-3015

Provider Business Practice Location Address
First Line	:	21263 ERWIN STREET
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5723
Country	:	US
Telephone Number	:	818-592-3056
Fax Number	:	818-592-3015

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

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	12/22/2021

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