Individual
DR. KENNETH KENJI TANABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, YAW 7B, BOSTON, MA 02114-2621
(617) 724-3868
(617) 724-3895
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
78104
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078104
TUFTS HEALTH PLAN
MA
05
—
3114015
—
MA
01
—
J13876
BCBS MA
MA
Enumeration date
11/03/2005
Last updated
11/06/2012
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