Organization
BRIAN H. ITAGAKI M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN HIRO ITAGAKI M.D. (PRESIDENT)
(213) 484-7303
Entity
Organization
Contact information
Practice address
2200 W 3RD ST, SUITE 120A, LOS ANGELES, CA 90057-1932
(213) 484-7303
(213) 484-7399
Mailing address
2200 W 3RD ST, 120A, LOS ANGELES, CA 90057-1932
(213) 484-7303
(213) 484-7399
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G37936
CA
Other
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
Enumeration date
01/29/2007
Last updated
04/12/2013
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