Provider Demographics
NPI:1528313665
Name:TAKEZAWA, TOMOKO (LMT)
Entity type:Individual
Prefix:MISS
First Name:TOMOKO
Middle Name:
Last Name:TAKEZAWA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7192 KALANIANAOLE HWY
Mailing Address - Street 2:STE E207A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1800
Mailing Address - Country:US
Mailing Address - Phone:808-226-5321
Mailing Address - Fax:
Practice Address - Street 1:7192 KALANIANAOLE HWY
Practice Address - Street 2:STE E207A
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1800
Practice Address - Country:US
Practice Address - Phone:808-226-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT12638171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor