Basic Information
| Provider Information | |||||||||
| NPI: | 1124411954 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAUL T IKUTA A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2757 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928590757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149732650 | ||||||||
| FaxNumber: | 7149732655 | ||||||||
| Practice Location | |||||||||
| Address1: | 16453 COLORADO AVE | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907235011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625313110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2015 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | IKUTA | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5623310759 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G42495 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.