Provider Demographics
NPI:1093210627
Name:ISHIBASHI, MEGAN (DPM)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ISHIBASHI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11860 WILSHIRE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6654
Mailing Address - Country:US
Mailing Address - Phone:310-853-0084
Mailing Address - Fax:310-388-1113
Practice Address - Street 1:11860 WILSHIRE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6654
Practice Address - Country:US
Practice Address - Phone:310-853-0084
Practice Address - Fax:310-388-1113
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5719213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist