1053496455 NPI number — DR. JONAS A NAVICKAS DO

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 1053496455 NPI number — DR. JONAS A NAVICKAS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAVICKAS
Provider First Name:
JONAS
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1053496455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56-119 PUALALEA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAHUKU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96731-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-293-9231
Provider Business Mailing Address Fax Number:
808-293-1151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2239 N SCHOOL ST
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:
96819-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-791-9400
Provider Business Practice Location Address Fax Number:
808-848-0979
Provider Enumeration Date:
10/25/2006

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: 207Q00000X , with the licence number:  DOS-783 , 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: 0000992101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000208298 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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