Takashi Michael Wada, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A56010 Issued in CA

Practice address

1845 N Fair Oaks Ave
Pasadena, CA 91103-1620

Phone

(626) 744-6005

NPI assigned

May 24, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184835811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3233 TERZILLA PL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900654824",
            "telephone_number": "323-559-0490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 N FAIR OAKS AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911031620",
            "telephone_number": "626-744-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADA",
        "first_name": "TAKASHI",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A56010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A56010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• W. Frederick Stephens,DDS,Inc (The Pacific Coast Center for Oral & Facial Surgery)
• W.James Henneberg, M.D. Inc.
• Jamie Fauve Waarbroek, PMNHNP-BC
• Elizabeth Wachsman, M.D.
• Matthew Wada
• Carley Ann Wade, OTR/L
• Levi Carl Wade
• Vanessa Mary Wade, LVN
• Tina Godwin Wadiwala, D.O.
• Corinne Rebecca Wadley

• Family Medicine Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.