Basic Information
| Provider Information | |||||||||
| NPI: | 1336536168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAKASE | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | KEIKO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ISAKI | ||||||||
| OtherFirstName: | MARISSA | ||||||||
| OtherMiddleName: | KEIKO | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1356 LUSITANA ST STE 510 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085862890 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1356 LUSITANA ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085862890 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD-19622 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.