1588724819 NPI number — MR. PAUL KEN MATSUMOTO MPT

Table of content: MR. PAUL KEN MATSUMOTO MPT (NPI 1588724819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588724819 NPI number — MR. PAUL KEN MATSUMOTO MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATSUMOTO
Provider First Name:
PAUL
Provider Middle Name:
KEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1588724819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 KAPIOLANI BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-596-9446
Provider Business Mailing Address Fax Number:
808-596-9160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 KAPIOLANI BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-596-9446
Provider Business Practice Location Address Fax Number:
808-596-9160
Provider Enumeration Date:
12/08/2006

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: 2251X0800X , with the licence number:  1772 , 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: 20-0684033 . This is a "HMAA NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 201834 . This is a "HMA NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: Z1654 . This is a "QUEENS HEALTH CARE PLAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: C0223549 . This is a "HMSA NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 3740566 . This is a "UHA NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00C0223549 . This is a "HMSA QUEST NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 24883001 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200684033 . This is a "UHC NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 201834 . This is a "SUMMERLIN NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 209006700 . This is a "OWCP NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 24883003 . This is a "ALOHA CARE NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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