1023144714 NPI number — WAIKIKI FAMILY PRACTICE PHYSICIANS LLC

Table of content: (NPI 1023144714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023144714 NPI number — WAIKIKI FAMILY PRACTICE PHYSICIANS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAIKIKI FAMILY PRACTICE PHYSICIANS 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:
1023144714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2424 KALAKAUA AVENUE
Provider Second Line Business Mailing Address:
SUITE 476A
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96815-3233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-922-6000
Provider Business Mailing Address Fax Number:
808-922-2680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 KALAKAUA AVENUE
Provider Second Line Business Practice Location Address:
SUITE 476A
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96815-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-922-6000
Provider Business Practice Location Address Fax Number:
808-922-2680
Provider Enumeration Date:
02/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUKELOW
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
HARRY
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
808-922-6000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD13296 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 13296 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: MD13253 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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