Healthcare Provider Details

I. General information

NPI: 1770603748
Provider Name (Legal Business Name): ALAN MINORU TANIGUCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-710 KEAAHALA RD
KANEOHE HI
96744-3528
US

IV. Provider business mailing address

45-710 KEAAHALA RD
KANEOHE HI
96744-3528
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2191
  • Fax:
Mailing address:
  • Phone: 808-247-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD2663
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: