Healthcare Provider Details

I. General information

NPI: 1609730290
Provider Name (Legal Business Name): ELENA CHEN TAN L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 14TH AVE
HONOLULU HI
96816-3629
US

IV. Provider business mailing address

1005 14TH AVE
HONOLULU HI
96816-3629
US

V. Phone/Fax

Practice location:
  • Phone: 808-259-1866
  • Fax:
Mailing address:
  • Phone: 808-259-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU-445
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: