Provider Demographics
NPI:1316948458
Name:TAKIGUCHI, DEAN KENJI (PT)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:KENJI
Last Name:TAKIGUCHI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SPRINGFLOWER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7588
Mailing Address - Country:US
Mailing Address - Phone:949-653-1250
Mailing Address - Fax:
Practice Address - Street 1:6082 EDINGER AVE
Practice Address - Street 2:STE 100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3264
Practice Address - Country:US
Practice Address - Phone:714-546-0811
Practice Address - Fax:714-546-3811
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT19659AMedicare ID - Type Unspecified
WPT19659BMedicare ID - Type Unspecified