1053454959 NPI number — DON QUIJOTE (USA) CO., LTD.

Table of content: (NPI 1053454959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053454959 NPI number — DON QUIJOTE (USA) CO., LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DON QUIJOTE (USA) CO., LTD.
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:
1053454959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 KAHEKA 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:
96814-3725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-973-6600
Provider Business Mailing Address Fax Number:
808-973-4844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 HAHANI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-266-4434
Provider Business Practice Location Address Fax Number:
808-266-4450
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUSHIKUMA
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
K
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
808-973-6600

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY-291 , 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: 00101401 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120 0738 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: A0261550 . This is a "HMSA PROVIDER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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