Provider Demographics
NPI:1700893559
Name:TASAKI, MITCHELL N (MD)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:N
Last Name:TASAKI
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 1:1885 MAIN ST
Mailing Address - Street 2:STE 206
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793
Mailing Address - Country:US
Mailing Address - Phone:808-242-8877
Mailing Address - Fax:808-242-1664
Practice Address - Street 1:1885 MAIN ST
Practice Address - Street 2:STE 206
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-242-8877
Practice Address - Fax:808-242-1664
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9619208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI008697601Medicaid
HI50679Medicare ID - Type Unspecified
HI008697601Medicaid