Provider Demographics
NPI:1881843050
Name:TANAKA, SCOTT KIYOSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KIYOSHI
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 1:4060 4TH AVE.
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-299-8500
Mailing Address - Fax:619-299-3370
Practice Address - Street 1:4060 4TH AVE.
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-299-8500
Practice Address - Fax:619-299-3370
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA002983207X00000X
CAA129847207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA129847OtherCA LICENSE