Provider Demographics
NPI:1124047634
Name:TANABE, ANNE AYAE (MD)
Entity type:Individual
Prefix:MISS
First Name:ANNE
Middle Name:AYAE
Last Name:TANABE
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 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-536-7546
Mailing Address - Fax:808-536-7553
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-536-7546
Practice Address - Fax:808-536-7553
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIOOA0229169OtherHMSA
HI50182602Medicaid
HIOOA0229169OtherHMSA
HI50182602Medicaid
HIH32021Medicare UPIN