1063643070 NPI number — THOMAS K L LAU MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063643070 NPI number — THOMAS K L LAU MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS K L LAU MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063643070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 S BERETANIA ST
Provider Second Line Business Mailing Address:
605
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-2414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-523-9363
Provider Business Mailing Address Fax Number:
808-523-9418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 MILILANI ST
Provider Second Line Business Practice Location Address:
702A
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-523-9363
Provider Business Practice Location Address Fax Number:
808-523-9418
Provider Enumeration Date:
08/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SALVADOR
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
808-523-9363

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  MD816 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000076307 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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