Provider Demographics
NPI:1225387459
Name:TANIGUCHI, LISA DUONG (AU D)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DUONG
Last Name:TANIGUCHI
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:677 ALA MOANA BLVD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5419
Mailing Address - Country:US
Mailing Address - Phone:808-692-1583
Mailing Address - Fax:808-566-6292
Practice Address - Street 1:677 ALA MOANA BLVD
Practice Address - Street 2:SUITE 625
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5419
Practice Address - Country:US
Practice Address - Phone:808-692-1583
Practice Address - Fax:808-566-6292
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1757231H00000X
WALD60464380231H00000X
HI172231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist