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Grace Chang Takahashi

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

757 Westwood Plz # Gou, Los Angeles, CA 90095-1324

PECOS Enrollment

This provider is enrolled in PECOS as GRACE TAKAHASHI.

Based on the most recent information from CMS, provider Grace Chang Takahashi is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 11:47 AM.

Profile Details

Provider ID
1235473976
Provider Type
Individual
Full Name
Takahashi, Grace Chang
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
11/19/2012
Last Updated
11/22/2021

Contact Information

Practice Location

757 Westwood Plz # Gou, Los Angeles, CA 90095-1324

(310) 267-6654

Unlisted Fax

Mailing Location

757 Westwood Plz # Gou, Los Angeles, CA 90095-8358

(310) 267-6654

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License NP20600 California
Code 363LC0200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License NP20600 California

Grace Chang Takahashi

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Shin, Valerie Soojung

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Lopez Chicas, Rafael

Hill, Patrick

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Kanlilar-Ruiz, Basak Julia

Lee, Soo-Min S

Bantugan, Leonora B

Varma, Jennifer