Provider Demographics
NPI:1326890708
Name:KRISTI TANAKA LLC
Entity Type:Organization
Organization Name:KRISTI TANAKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:TANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCSW
Authorized Official - Phone:808-374-0094
Mailing Address - Street 1:21739 HARDY OAK BLVD APT 6307
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2381
Mailing Address - Country:US
Mailing Address - Phone:808-220-8044
Mailing Address - Fax:
Practice Address - Street 1:45-270 WILLIAM HENRY RD STE 207
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5808
Practice Address - Country:US
Practice Address - Phone:808-379-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRISTI TANAKA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty