1093054066 NPI number — JAMIE LEIALOHA VARES CHINEN MAT

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 1093054066 NPI number — JAMIE LEIALOHA VARES CHINEN MAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHINEN
Provider First Name:
JAMIE
Provider Middle Name:
LEIALOHA VARES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VARES
Provider Other First Name:
JAMIE
Provider Other Middle Name:
LEIALOHA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093054066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99-128 AIEA HEIGHTS DR
Provider Second Line Business Mailing Address:
STE 505
Provider Business Mailing Address City Name:
AIEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96701-3925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-382-1892
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99-128 AIEA HEIGHTS DR
Provider Second Line Business Practice Location Address:
STE 505
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-382-1892
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  12218 , 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)





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