Provider Demographics
NPI:1366625451
Name:H. GEORGE TANAKA, M.D., P.C.
Entity Type:Organization
Organization Name:H. GEORGE TANAKA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:TANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-771-4020
Mailing Address - Street 1:1515 SCOTT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3511
Mailing Address - Country:US
Mailing Address - Phone:415-771-4020
Mailing Address - Fax:415-771-4095
Practice Address - Street 1:1515 SCOTT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3511
Practice Address - Country:US
Practice Address - Phone:415-771-4020
Practice Address - Fax:415-771-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78526207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG77949Medicare UPIN