Provider Demographics
NPI:1417153008
Name:TAKENAKA, CODY MAYUMI (MD)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:MAYUMI
Last Name:TAKENAKA
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 1:677 ALA MOANA BLVD
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5419
Mailing Address - Country:US
Mailing Address - Phone:808-523-8461
Mailing Address - Fax:
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:HPM-9
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2336
Practice Address - Country:US
Practice Address - Phone:808-523-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-5297207R00000X
HIMD15656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine