1619591286 NPI number — DR. JOSEPH TANAEL GO MD

Table of content: DR. JOSEPH TANAEL GO MD (NPI 1619591286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619591286 NPI number — DR. JOSEPH TANAEL GO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GO
Provider First Name:
JOSEPH
Provider Middle Name:
TANAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GO
Provider Other First Name:
JOSEPH RAYMOND
Provider Other Middle Name:
TANAEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619591286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 S BERETANIA ST STE 401
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:
96813-2496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-691-7744
Provider Business Mailing Address Fax Number:
808-691-4005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 S BERETANIA ST STE 401
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:
96813-2496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-691-7744
Provider Business Practice Location Address Fax Number:
808-691-4005
Provider Enumeration Date:
05/29/2020

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: 207R00000X , with the licence number:  MD-23564 , 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)