Provider Demographics
NPI:1205963121
Name:TAKEDA, KARA MEGUMI (OD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:MEGUMI
Last Name:TAKEDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4198 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-3100
Mailing Address - Country:US
Mailing Address - Phone:562-420-1133
Mailing Address - Fax:562-420-6126
Practice Address - Street 1:4198 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-3100
Practice Address - Country:US
Practice Address - Phone:562-420-1133
Practice Address - Fax:562-420-6126
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12862T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist