Provider Demographics
NPI:1285079830
Name:TAKAOKA, YOSHIRO (MD)
Entity type:Individual
Prefix:
First Name:YOSHIRO
Middle Name:
Last Name:TAKAOKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5249
Mailing Address - Country:US
Mailing Address - Phone:216-591-1005
Mailing Address - Fax:
Practice Address - Street 1:5 FOXWOOD LN
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-5249
Practice Address - Country:US
Practice Address - Phone:216-591-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.039143282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1558607457Medicare PIN