Individual
KENICHI TANAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
920 STANTON L YOUNG BLVD # WP1140, OKLAHOMA CITY, OK 73104-5036
(405) 271-4351
(405) 271-8695
Mailing address
PO BOX 26901, WP1140, OKLAHOMA CITY, OK 73126-0901
(405) 271-4351
(405) 271-8695
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
37436
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045348
GA LICENSE
GA
Enumeration date
07/09/2006
Last updated
02/02/2021
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