Provider Demographics
NPI:1871577890
Name:TAKASH, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:TAKASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5333
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-5333
Mailing Address - Country:US
Mailing Address - Phone:310-329-2469
Mailing Address - Fax:310-329-0176
Practice Address - Street 1:1035 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2699
Practice Address - Country:US
Practice Address - Phone:310-329-2469
Practice Address - Fax:310-329-0176
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2024-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG64633207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64633FMedicare PIN
CAG64633DMedicare PIN
CAE88974Medicare UPIN
CAG64633EMedicare PIN
CAG64633CMedicare PIN