Healthcare Provider Details

I. General information

NPI: 1942696489
Provider Name (Legal Business Name): AILEEN TANAKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 950
HONOLULU HI
96814-1874
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 950
HONOLULU HI
96814-1874
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-6676
  • Fax: 808-373-7577
Mailing address:
  • Phone: 808-983-6676
  • Fax: 808-373-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD-21306
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: