Provider Demographics
NPI:1497489447
Name:LEO TANAKA MD INC
Entity Type:Organization
Organization Name:LEO TANAKA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HIDEAKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:TANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-830-0884
Mailing Address - Street 1:9600 CUYAMACA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2692
Mailing Address - Country:US
Mailing Address - Phone:619-258-6200
Mailing Address - Fax:619-258-0028
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-740-6000
Practice Address - Fax:619-740-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124280730Medicaid