1851509202 NPI number — TODD H.M. MIRZAI,M.D.,LLC

Table of content: (NPI 1851509202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851509202 NPI number — TODD H.M. MIRZAI,M.D.,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TODD H.M. MIRZAI,M.D.,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:
1851509202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1939 E VINEYARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAILUKU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96793-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-249-8509
Provider Business Mailing Address Fax Number:
808-242-9166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1907 S BERETANIA ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96826-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-952-9779
Provider Business Practice Location Address Fax Number:
808-952-9988
Provider Enumeration Date:
05/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MIRZAI
Authorized Official First Name:
TODD
Authorized Official Middle Name:
H.M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-952-9779

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD11980 , 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: D0236093 . This is a "KAUAI HMSA PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: P00019092 . This is a "MEDICARE RAILROAD PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: E0236090 . This is a "MAUI 2 HMSA PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: A236099 . This is a "MAUI HMSA PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 5797799 . This is a "UHA PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: C236095 . This is a "HMSA OAHU PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".