Provider Demographics
NPI:1528058336
Name:TAKAYESU, JAMES KIMO (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KIMO
Last Name:TAKAYESU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:5 EMERSON PLACE, MGH
Practice Address - Street 2:EMERGENCY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-5636
Practice Address - Fax:617-724-0917
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA216475207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2004933Medicaid
MA408265OtherTUFTS HEALTH PLAN
MAJ26000OtherBCBS MA
H85896Medicare UPIN
MAA35339Medicare ID - Type Unspecified