Provider Demographics
NPI:1164590097
Name:THOMAS K TASAKI MD INC
Entity Type:Organization
Organization Name:THOMAS K TASAKI MD INC
Other - Org Name:THOMAS TASAKI K MD,INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KEN
Authorized Official - Last Name:TASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-380-6633
Mailing Address - Street 1:1380 LUSITANA ST STE 710
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2443
Mailing Address - Country:US
Mailing Address - Phone:808-380-6633
Mailing Address - Fax:
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 710
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2421
Practice Address - Country:US
Practice Address - Phone:808-380-6633
Practice Address - Fax:808-744-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4907174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID01715-4OtherHMSA
HI015993-01Medicaid
HI015993-01Medicaid
HID01715-4OtherHMSA