Individual ProviderTakahiro ShiotaInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address127 S San Vicente Blvd Ste A3600, Los Angeles, CA 90048-3311(310) 423-2726PECOS EnrollmentBased on the most recent information from CMS, provider Takahiro Shiota is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1972603868Provider TypeIndividualFull NameShiota, TakahiroCredentialMDGenderMaleSole ProprietorNoEnumeration Date9/22/2006Last Updated10/27/2022Contact InformationPractice LocationPractice Address127 S San Vicente Blvd Ste A3600, Los Angeles, CA 90048-3311Phone(310) 423-2726Fax(310) 423-6795Mailing LocationMailing Address4140 W 190th St, Torrance, CA 90504-5513Phone(310) 423-2726FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207RC0000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseSFP15CaliforniaCode207RC0000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense35080318OhioProvider IdentifiersIDDescriptionIssuerID2291363DescriptionMedicaidIssuerUnlistedOhio