1093462103 NPI number — DARRELL T NATORI MD INC

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 1093462103 NPI number — DARRELL T NATORI MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARRELL T NATORI MD INC
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:
1093462103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1329 LUSITANA ST STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-521-6622
Provider Business Mailing Address Fax Number:
808-521-6633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 LUSITANA ST STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-521-6622
Provider Business Practice Location Address Fax Number:
808-521-6633
Provider Enumeration Date:
03/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
NATORI
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
TAMOTSU
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-521-6622

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 076537 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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