Provider Demographics
NPI:1003084427
Name:PEDIATRIC PHYSICIANS GROUP
Entity Type:Organization
Organization Name:PEDIATRIC PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TANIGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-488-1990
Mailing Address - Street 1:98-1238 KAAHUMANU ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3250
Mailing Address - Country:US
Mailing Address - Phone:808-488-1990
Mailing Address - Fax:808-486-8495
Practice Address - Street 1:98-1238 KAAHUMANU ST STE 200
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3250
Practice Address - Country:US
Practice Address - Phone:808-488-1990
Practice Address - Fax:808-486-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56572301Medicaid
HI058717-02Medicaid
HI075723-01Medicaid