Provider Demographics
NPI:1275055832
Name:TANAKA TRANSPORT
Entity Type:Organization
Organization Name:TANAKA TRANSPORT
Other - Org Name:TANAKA TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAFARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGWENZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-517-0499
Mailing Address - Street 1:4353 GANNON LN STE 103A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4200
Mailing Address - Country:US
Mailing Address - Phone:214-517-0499
Mailing Address - Fax:
Practice Address - Street 1:4353 GANNON LN STE 103-A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:214-517-0499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)