1033117429 NPI number — DR. JON TOSHIHARU TANABE DDS

Table of content: DR. JON TOSHIHARU TANABE DDS (NPI 1033117429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033117429 NPI number — DR. JON TOSHIHARU TANABE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANABE
Provider First Name:
JON
Provider Middle Name:
TOSHIHARU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1033117429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 KAPIOLANI BLVD
Provider Second Line Business Mailing Address:
SUITE 515
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 KAPIOLANI BLVD
Provider Second Line Business Practice Location Address:
SUITE 515
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-596-0133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1434 , 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: 803865 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 1434 . This is a "HAWAII DENTAL SERVICE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 024056-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2674-0 . This is a "HAWAII MEDICAL SERVICE AS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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