1588724819 NPI number — MR. PAUL KEN MATSUMOTO MPT

Table of content: ALON DAGAN M.D. (NPI 1023451747)

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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