Individual
HIDEHISA THOMAS TAKEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7117 BROCKTON AVE, RIVERSIDE, CA 92506-2615
(951) 321-6355
(951) 784-3260
Mailing address
7117 BROCKTON AVE, RIVERSIDE, CA 92506-2658
(951) 321-6355
(951) 784-3260
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G68345
CA
2086S0129X
Vascular Surgery Physician
G68345
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730180415
GROUP NPI
CA
01
—
ZZZ31887Z
GROUP PTAN
CA
Enumeration date
11/23/2005
Last updated
04/11/2025
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