1417119363 NPI number — DR. SEAN SCOTT COVANT DO

Table of content: DR. SEAN SCOTT COVANT DO (NPI 1417119363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417119363 NPI number — DR. SEAN SCOTT COVANT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVANT
Provider First Name:
SEAN
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1417119363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 ULUNIU ST
Provider Second Line Business Mailing Address:
SUITE 411, PO BOX 1266
Provider Business Mailing Address City Name:
KAILUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96734-2519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-263-7203
Provider Business Mailing Address Fax Number:
808-261-3092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 ULUNIU ST
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-263-7203
Provider Business Practice Location Address Fax Number:
808-261-3092
Provider Enumeration Date:
07/01/2008

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: 207P00000X , with the licence number:  DOS- 1471 , 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)