Individual
CHIAKI MIURA JUTABHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2501 N SEPULVEDA BLVD STE 101, MANHATTAN BEACH, CA 90266-2722
(310) 546-8702
(310) 545-5310
Mailing address
5767 W CENTURY BLVD, SUITE 200, LOS ANGELES, CA 90045-5632
(310) 829-9935
(310) 829-1077
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A64833
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A648330
—
CA
Enumeration date
08/11/2006
Last updated
07/21/2022
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