Doctor Name: | DR. RUSSELL K TASAKA |
NPI Number: | 1841308723 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DMD |
License Number: | 1612 |
Business Practice Address: | 3221 Waialae Ave Ste 376 Honolulu, HI - 96816 |
Business Phone Number: | 8087379032 |
Business Fax Number: | 8087370290 |
Mailing Address: | 3221 Waialae Ave, Ste 376 HONOLULU |
State: | HI |
Postal Code: | 96816 |
Phone Number: | 8087379032 |
Fax Number: | 8087370290 |
NPI Enumeration Date: | 08/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 1612 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |