Provider Demographics
NPI:1508032046
Name:TAKEDA, EIJI (LAC)
Entity Type:Individual
Prefix:MR
First Name:EIJI
Middle Name:
Last Name:TAKEDA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 KAMAOLE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2816
Mailing Address - Country:US
Mailing Address - Phone:808-389-0823
Mailing Address - Fax:
Practice Address - Street 1:1040 KAMAOLE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-2816
Practice Address - Country:US
Practice Address - Phone:808-389-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 838171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist