1982887279 NPI number — DR FREDRICK L YOST, LLC

Table of content: (NPI 1982887279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982887279 NPI number — DR FREDRICK L YOST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR FREDRICK L YOST, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1982887279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1508 LEHIA ST
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:
96818-1829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-421-9678
Provider Business Mailing Address Fax Number:
808-423-1109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 LUSITANA ST STE 614
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:
96813-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-535-9678
Provider Business Practice Location Address Fax Number:
808-423-1109
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOST
Authorized Official First Name:
FREDRICK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-421-9678

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD-8791 , 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: 25296601 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00C0218150 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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