Provider Demographics
NPI:1619396900
Name:TANAKA, KUMIKO E (MD)
Entity type:Individual
Prefix:DR
First Name:KUMIKO
Middle Name:E
Last Name:TANAKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1929
Mailing Address - Country:US
Mailing Address - Phone:781-263-9110
Mailing Address - Fax:781-263-9125
Practice Address - Street 1:30 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1929
Practice Address - Country:US
Practice Address - Phone:781-263-9110
Practice Address - Fax:781-263-9125
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16361207V00000X
MA286473207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology