Provider Demographics
NPI:1861580649
Name:TANAKA, TERRI T (MD)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:T
Last Name:TANAKA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:95-1249 MEHEULA PKWY
Mailing Address - Street 2:UNIT 187
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1779
Mailing Address - Country:US
Mailing Address - Phone:808-625-6444
Mailing Address - Fax:808-623-2552
Practice Address - Street 1:95-1249 MEHEULA PKWY
Practice Address - Street 2:UNIT 187
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1779
Practice Address - Country:US
Practice Address - Phone:808-625-6444
Practice Address - Fax:808-623-2552
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-7509208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF61254Medicare UPIN