1124363981 NPI number — SUSAN S. HIRAOKA, DPM, LLC

Table of content: (NPI 1124363981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124363981 NPI number — SUSAN S. HIRAOKA, DPM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN S. HIRAOKA, DPM, 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:
1124363981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
642 ULUKAHIKI ST
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
KAILUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96734-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-261-9931
Provider Business Mailing Address Fax Number:
808-262-9986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
642 ULUKAHIKI ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-261-9931
Provider Business Practice Location Address Fax Number:
808-262-9986
Provider Enumeration Date:
12/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HIRAOKA
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PHYSICAN
Authorized Official Telephone Number:
808-261-9931

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  PO-155 , 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: 501074 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23066-4 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 464973 . This is a "OHANA HEALTH" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".