Provider Demographics
NPI:1417967332
Name:TANAKA, ALAN KENICHI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KENICHI
Last Name:TANAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-545-1557
Mailing Address - Fax:808-545-5743
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 306
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-545-1557
Practice Address - Fax:808-545-5743
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIE03421207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI023088-01Medicaid
HIH0000BDVCBMedicare PIN
HI023088-01Medicaid