1356494157 NPI number — TAK PROPERTIES, LLC.

Table of content: (NPI 1356494157)

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".




Copyright © 2007-2025 www.npivalidator.com