1760689798 NPI number — GARRET NOGUCHI DPM LLC

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 1760689798 NPI number — GARRET NOGUCHI DPM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARRET NOGUCHI DPM LLC
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:
1760689798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 N KUAKINI ST
Provider Second Line Business Mailing Address:
#801
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-2364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-521-2002
Provider Business Mailing Address Fax Number:
808-521-0351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 N KUAKINI ST
Provider Second Line Business Practice Location Address:
#801
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-521-2002
Provider Business Practice Location Address Fax Number:
808-521-0351
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NOGUCHI
Authorized Official First Name:
WAKA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
808-521-2002

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO131 , 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: 08079401 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1649383415 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 21076-5 . This is a "HMSA PROVIDER NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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