# BRIAN H. ITAGAKI M.D., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710023718
- **Authorized official:** DR. BRIAN HIRO ITAGAKI M.D. (PRESIDENT)
- **Authorized official phone:** (213) 484-7303

## Contact information

- **Practice address:** 2200 W 3RD ST, SUITE 120A, LOS ANGELES, CA 90057-1932
- **Practice address phone:** (213) 484-7303
- **Practice address fax:** (213) 484-7399
- **Mailing address:** 2200 W 3RD ST, 120A, LOS ANGELES, CA 90057-1932
- **Mailing address phone:** (213) 484-7303
- **Mailing address fax:** (213) 484-7399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G37936 | CA | Yes |

## Other

- **Enumeration date:** 01/29/2007
- **Last updated:** 04/12/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0004227410 | AETNA | CA |
| 01 | — | 006379360 | BLUE SHIELD | CA |
| 05 | — | 00G379360 | — | CA |
| 01 | — | 155649300 | DEPARTMENT OF LABOR | CA |
| 01 | — | G37936 | MEDICARE INDIVIDUAL PTAN | CA |