Individual
MR. LAURENCE K TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4060 FOURTH AVENUE, SUITE 330, SAN DIEGO, CA 92103
(619) 298-9931
(619) 298-3613
Mailing address
4060 FOURTH AVENUE, SUITE 330, SAN DIEGO, CA 92103
(619) 298-9931
(619) 298-3613
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
011646
LA
208600000X
Surgery Physician
Primary
C34455
CA
208600000X
Surgery Physician
MD2833
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9815915
—
CA
Enumeration date
12/01/2006
Last updated
11/23/2011
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