1013036128 NPI number — MATSUYAMAS O D INC

Table of content: (NPI 1013036128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013036128 NPI number — MATSUYAMAS O D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATSUYAMAS O D INC
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:
6
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:
1013036128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98-150 KAONOHI ST
Provider Second Line Business Mailing Address:
B211
Provider Business Mailing Address City Name:
AIEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96701-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-486-3937
Provider Business Mailing Address Fax Number:
808-486-3386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98-150 KAONOHI ST
Provider Second Line Business Practice Location Address:
B211
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-486-3937
Provider Business Practice Location Address Fax Number:
808-486-3386
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MATSUYAMA
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
SUSUMU
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-486-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  130 , 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: 05156700 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: B5892-1 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: HI90130 . This is a "VISION BENEFITS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00B0058921 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 576602066 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 05156701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 193775 . This is a "SUMMERLIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: OP0579 . This is a "EYEMED" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 193775 . This is a "HMA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 57660206621 . This is a "UNIVERSITY HEALTH ALLIANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 576602066264 . This is a "UNIVERSITY HEALTH ALLIANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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