1790885994 NPI number — DR. ALAN C DESILVA 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 1790885994 NPI number — DR. ALAN C DESILVA MD INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESILVA
Provider First Name:
ALAN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD INC.
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:
1790885994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1248 KINOOLE STREET
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-4171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-935-6888
Provider Business Mailing Address Fax Number:
808-961-0889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1248 KINOOLE STREET
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720-4171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-935-6888
Provider Business Practice Location Address Fax Number:
808-961-0889
Provider Enumeration Date:
09/25/2006

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:  3482 , 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: G0038 . This is a "BANKERS LIFE & CASUALTY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000044552 . This is a "BLUE CARD HAWAII" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 117987 . This is a "STATE OF HAWAII DEPT OF E" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 201361400 . This is a "US DEPT OF LABOR WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04047901 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C98746 . This is a "KAISER PERMANENTE SENIOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 99022440801 . This is a "COUNTY OF HAWAII WORKERS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000044552 . This is a "HMSA QUEST NO" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000044552 . This is a "HAWAII MEDICAL SERVICE AS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000044552 . This is a "HMSA FED EMPLOYEES PLAN N" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 04047901 . This is a "ALOHA CARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 19199801 . This is a "HAWAII MEDICAL ASSOCIATIO" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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