MEDICARE: JULIE T. TANABE GOO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DT-1891	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891	OTHER	HI	HDS PROVIDER NO.
2	DT 1891	OTHER	HI	STATE DENTIST LICENSE NO.
3	208538	OTHER	HI	HMSA PROVIDER NO.

General Provider Information

NPI Number	:	1912082348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE T. TANABE GOO D.D.S.

Provider Business Mailing Address
First Line	:	3538 WAIALAE AVE STE 206
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-2742
Country	:	US
Telephone Number	:	808-734-8969
Fax Number	:	808-737-2634

Provider Business Practice Location Address
First Line	:	3538 WAIALAE AVE STE 206
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-2742
Country	:	US
Telephone Number	:	808-734-8969
Fax Number	:	808-737-2634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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