Healthcare Provider Details

I. General information

NPI: 1861580649
Provider Name (Legal Business Name): TERRI T. TANAKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1249 MEHEULA PKWY UNIT 187
MILILANI HI
96789-1779
US

IV. Provider business mailing address

95-1249 MEHEULA PKWY UNIT 187
MILILANI HI
96789-1779
US

V. Phone/Fax

Practice location:
  • Phone: 808-625-6444
  • Fax: 808-623-2552
Mailing address:
  • Phone: 808-625-6444
  • Fax: 808-623-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-7509
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: