Provider Demographics
NPI:1043328511
Name:ISHIMARU-TSENG, TAKAKO VIVIAN (MD)
Entity Type:Individual
Prefix:
First Name:TAKAKO
Middle Name:VIVIAN
Last Name:ISHIMARU-TSENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 LILIHA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1650
Mailing Address - Country:US
Mailing Address - Phone:808-531-5070
Mailing Address - Fax:808-531-5074
Practice Address - Street 1:2228 LILIHA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1650
Practice Address - Country:US
Practice Address - Phone:808-531-5070
Practice Address - Fax:808-531-5074
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-102282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI554908-01Medicaid