1861454712 NPI number — MR. DAVID TERRANCE REPKING IDC

Table of content: MR. DAVID TERRANCE REPKING IDC (NPI 1861454712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861454712 NPI number — MR. DAVID TERRANCE REPKING IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REPKING
Provider First Name:
DAVID
Provider Middle Name:
TERRANCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC
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:
1861454712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
156 CHUNG-HOON PL
Provider Second Line Business Mailing Address:
102
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96818-7367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-473-1014
Provider Business Mailing Address Fax Number:
808-473-3109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
822 CLARK ST
Provider Second Line Business Practice Location Address:
USS HONOLULU SSN718 SUITE 400
Provider Business Practice Location Address City Name:
PEARL HARBOR
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96860-4652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-474-1128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2006

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: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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