Individual
JOHN M. ITAMURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 N LAKE AVE STE 201, PASADENA, CA 91101-5120
(626) 568-9030
Mailing address
6801 PARK TER, LOS ANGELES, CA 90045-1543
(310) 665-7200
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G69735
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G697350
BLUE SHIELD
CA
05
—
00G697350
—
CA
Enumeration date
05/19/2006
Last updated
02/09/2021
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