Provider Demographics
NPI:1053866715
Name:RUSSELL K TASAKA, DMD
Entity Type:Organization
Organization Name:RUSSELL K TASAKA, DMD
Other - Org Name:KALIHI CENTER FOR DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-737-9032
Mailing Address - Street 1:2024 N KING ST
Mailing Address - Street 2:107
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3456
Mailing Address - Country:US
Mailing Address - Phone:808-841-7944
Mailing Address - Fax:808-841-7945
Practice Address - Street 1:2024 N KING ST
Practice Address - Street 2:107
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3456
Practice Address - Country:US
Practice Address - Phone:808-841-7944
Practice Address - Fax:808-841-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI056033-01Medicaid