Provider Demographics
NPI:1275524589
Name:TSUTAOKA, ELSA K (MD)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:K
Last Name:TSUTAOKA
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 1:401 KAMOKILA BLVD
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-5607
Mailing Address - Country:US
Mailing Address - Phone:808-432-3600
Mailing Address - Fax:
Practice Address - Street 1:401 KAMOKILA BLVD
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-5607
Practice Address - Country:US
Practice Address - Phone:808-432-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61609207Q00000X
HIMD-22163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA616090OtherBLUE SHIELD
CAOOA616090Medicaid
CAOOA616090OtherBLUE SHIELD
CAOOA616090Medicaid