Basic Information
| Provider Information | |||||||||
| NPI: | 1568836195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELAINE TSUKAYAMA, MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 848 S BERETANIA ST | ||||||||
| Address2: | STE. 400 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085360314 | ||||||||
| FaxNumber: | 8085360320 | ||||||||
| Practice Location | |||||||||
| Address1: | 1380 LUSITANA ST | ||||||||
| Address2: | STE 907 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085242885 | ||||||||
| FaxNumber: | 8085242886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2015 | ||||||||
| LastUpdateDate: | 11/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | TSUKAYAMA | ||||||||
| AuthorizedOfficialFirstName: | ELAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8085242885 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD-17743 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.