Individual
GEN TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
940 BELMONT ST, PSYCHIATRY 116A7, BROCKTON, MA 02301-5596
(774) 826-2458
Mailing address
75 DONALD ST, APT 58, WEYMOUTH, MA 02188-3962
(310) 793-6152
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
248497
MA
Other
Enumeration date
08/30/2011
Last updated
08/30/2011
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