Provider Demographics
NPI:1285951137
Name:TAKEZAWA, SAYAKA (LAC)
Entity type:Individual
Prefix:
First Name:SAYAKA
Middle Name:
Last Name:TAKEZAWA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 TROLLEY COURT
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823
Mailing Address - Country:US
Mailing Address - Phone:323-636-3630
Mailing Address - Fax:
Practice Address - Street 1:6300 WILSHIRE BLVD #160
Practice Address - Street 2:SUITE #165
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-855-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12998171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist