Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 33185 | CA |
Y | 111NN0400X | Neurology | DC-1422 | HI |
NPI | 1134512809 |
---|---|
Provider Name | Dr. Josuke Tanaka |
First Address | Mililani, HI 96789-2909 |
Second Address | Mililani, HI 96789-2909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2015 |
Last Update Date | 20/02/2019 |