Individual
GLENN SHIGEO TAKATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4650 W SUNSET BLVD, LOS ANGELES, CA 90027-6062
(323) 669-2534
(323) 906-8003
Mailing address
3701 W SUNSET BLVD, SUITE 600, LOS ANGELES, CA 90026-1527
(323) 669-2337
(323) 644-8488
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G52851
CA
208D00000X
General Practice Physician
G52851
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G528510
—
CA
Enumeration date
09/15/2006
Last updated
02/01/2017
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