1477655116 NPI number — DR. SHOZO OGAWA M.D.

Table of content: DR. SHOZO OGAWA M.D. (NPI 1477655116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477655116 NPI number — DR. SHOZO OGAWA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGAWA
Provider First Name:
SHOZO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1477655116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 KAPIOLANI BLVD, #2000
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:
96814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-945-3719
Provider Business Mailing Address Fax Number:
808-945-3629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2065 S KING ST STE 201
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:
96826-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-941-3766
Provider Business Practice Location Address Fax Number:
808-942-2775
Provider Enumeration Date:
09/02/2006

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: 207R00000X , with the licence number:  MD2014 , 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: 03148101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034892 . This is a "BCBS OF HAWAII (HMSA)" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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