Provider Demographics
NPI:1962608034
Name:KAGAWA, TAKUMI J (DDS)
Entity type:Individual
Prefix:
First Name:TAKUMI
Middle Name:J
Last Name:KAGAWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E THIRD ST
Mailing Address - Street 2:SUITE #1008
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013
Mailing Address - Country:US
Mailing Address - Phone:213-625-7141
Mailing Address - Fax:213-625-7167
Practice Address - Street 1:420 E THIRD ST
Practice Address - Street 2:SUITE #1008
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013
Practice Address - Country:US
Practice Address - Phone:213-625-7141
Practice Address - Fax:213-625-7167
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243091223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics