Provider Demographics
NPI:1306954979
Name:TAKI N ANAGNOSTON MEDICAL CORPORATION
Entity type:Organization
Organization Name:TAKI N ANAGNOSTON MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKI
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANAGNOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-847-3100
Mailing Address - Street 1:700 W 6TH ST STE R
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6014
Mailing Address - Country:US
Mailing Address - Phone:408-847-3100
Mailing Address - Fax:418-847-4925
Practice Address - Street 1:700 W 6TH ST STE R
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6014
Practice Address - Country:US
Practice Address - Phone:408-847-3100
Practice Address - Fax:418-847-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0C22061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0001420Medicaid
CAA32068Medicare UPIN
CAGR0001420Medicaid