1104916196 NPI number — ANNE A TANABE MD INC

Table of content: (NPI 1104916196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104916196 NPI number — ANNE A TANABE MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNE A TANABE MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SKINNY DIP SKIN CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104916196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 N KUAKINI ST STE 402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-2386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-536-7546
Provider Business Mailing Address Fax Number:
808-536-7553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 N KUAKINI ST STE 402
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817-2386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-536-7546
Provider Business Practice Location Address Fax Number:
808-536-7553
Provider Enumeration Date:
10/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TANABE
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT, ANNE A TANABE MD INC.
Authorized Official Telephone Number:
808-536-7556

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD11057 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1124047634 . This is a "NPI FOR INDIVIDUAL" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 56703 . This is a "GROUP PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 50182602 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56705 . This is a "PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0229169 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".