Provider Demographics
NPI:1245641448
Name:TACHIBANA, FAYE (MD)
Entity type:Individual
Prefix:MS
First Name:FAYE
Middle Name:
Last Name:TACHIBANA
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 1:98-151 PALI MOMI ST STE 142
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4333
Mailing Address - Country:US
Mailing Address - Phone:808-483-6400
Mailing Address - Fax:808-483-6434
Practice Address - Street 1:98-151 PALI MOMI ST STE 142
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4333
Practice Address - Country:US
Practice Address - Phone:808-483-6400
Practice Address - Fax:808-483-6434
Is Sole Proprietor?:No
Enumeration Date:2014-05-11
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-19029207R00000X, 207K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program