1356494157 NPI number — TAK PROPERTIES, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356494157 NPI number — TAK PROPERTIES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAK PROPERTIES, LLC.
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:
Provider Other Organization Name Type Code:
6
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:
1356494157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94-141 PUPUPUHI ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIPAHU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96797-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-671-2528
Provider Business Mailing Address Fax Number:
808-678-1894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91-2139 FORT WEAVER RD
Provider Second Line Business Practice Location Address:
ST. FRANCIS MEDICAL PLAZA-WEST #101A
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-676-2688
Provider Business Practice Location Address Fax Number:
808-676-2699
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TOLENTINO
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
808-671-2528

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  PT-1339 , 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: 501032-04 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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