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NPI Code Detail

MEDICARE: DR. RANDALL T TANAKA DDS

MEDICARE: DR. RANDALL T TANAKA DDS
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
1122300000XDentist38928CA

General Provider Information

NPI Number : 1548269194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDALL T TANAKA DDS
Provider Business Mailing Address
First Line : 4921 DEHESA RD
Second Line :
City : EL CAJON
State : CA
Zip : 92019-2929
Country : US
Telephone Number : 619-445-0707
Fax Number : 619-445-0901
Provider Business Practice Location Address
First Line : 4921 DEHESA RD
Second Line :
City : EL CAJON
State : CA
Zip : 92019-2929
Country : US
Telephone Number : 619-445-0707
Fax Number : 619-445-0901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2005
Last Update Date : 02/03/2026

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Directions to “ DR. RANDALL T TANAKA DDS” Practice Location

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