Provider Demographics
NPI:1326401274
Name:TANIGUCHI-FU, RANDI-LAURENT U
Entity Type:Individual
Prefix:
First Name:RANDI-LAURENT
Middle Name:U
Last Name:TANIGUCHI-FU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:
Other - Last Name:OLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0408
Mailing Address - Country:US
Mailing Address - Phone:808-553-3121
Mailing Address - Fax:808-553-3121
Practice Address - Street 1:280 HOME OLU PL
Practice Address - Street 2:
Practice Address - City:KAUNAKAAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-553-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD20433207R00000X
390200000X
HIMD-20433207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program